Reconstruction of the nose is one of the most challenging aspects of plastic surgery. The nose is a three dimensional structure made up of not only skin, but also muscle, cartilage, and bone. Aside from its cosmetic importance; the nose serves a vital function in breathing, smell, and taste. Dr. Naficy has been performing complex nasal reconstruction procedures for nearly 15 years. Dr. Naficy's textbook on nasal reconstruction is used by surgeons all over the world.
Nasal reconstruction by Sam Naficy, MD following removal of a basal cell carcinoma
Nose Reconstruction Slide Show
You may wish to browse through the gallery of representative before and after nose reconstruction pictures. Click on any of the thumbnails to enter the slide show. All reconstructive surgery procedures were performed by Dr. Sam Naficy.
Options In Nasal Reconstruction
Following removal of skin cancer from the nose, options for reconstructive surgery typically include one of the following:
This type of reconstruction is possible when there is enough loose skin on either side of the defect to allow for direct closure of the defect. To optimize the outcome, the adjacent tissue needs to be freed to allow movement without tension. Meticulous closure in layers, using fine suture material is performed.
Nasal reconstruction using primary closure by Sam Naficy, MD
Local Flap Closure
This type of reconstruction uses skin mobilized from one region of the nose to repair another region. The flap of skin is mobilized using multiple different combinations of incisions (cuts) yet still remains in part attached to its blood supply. Local flaps from the nose have a nice color and texture match to the defect, however, there is a limit to the size of defect that may be repaired with a local flap.
Nasal reconstruction using a local flap by Sam Naficy, MD
One of the most common flaps used for repair of Mohs defects of the nose is the bilobe flap pictured below. Bilobe flaps of the nose have a very good color and texture match to the defect, however, there is a limit to the size of defect that may be repaired with a bilobe flap. Typically Bilobe flaps are used for defects that are 1.5 cm or less in diameter.
Bilobe flap reconstruction of nose by Sam Naficy, MD
Skin Graft Closure
A skin graft is a piece of skin removed from another location in the face and transplanted onto the defect on the nose. A graft therefore lacks a blood supply of its own and must stay alive by drawing nutrients and blood supply from the wound. Grafts are therefore not as hardy as flaps and have a lower success rate. Grafts tend to be better when the defect is not very deep and when there is a nice, healthy layer at the bottom of the wound to support the graft. Skin grafts are often combined with cartilage grafts for reconstruction of the nose.
Nasal reconstruction using a skin and cartilage graft by Sam Naficy, MD
Regional Flap Closure
This type of multi-stage reconstruction uses skin mobilized from one region of the face (donor site) far from the nose to repair a defect on the nose. The flap of skin is mobilized using incisions (cuts) yet still remains in part attached to its original blood supply. Subsequent procedures are required to disconnect the bridge of skin from the donor side to the nose. Typical donor sites for regional flaps used to reconstruct the nose are the forehead and the cheek.
Nasal reconstruction using a regional flap by Sam Naficy, MD
If you are interested in having Dr. Naficy perform reconstruction of your skin cancer you may contact us to schedule an appointment for plastic surgery evaluation. One of our nursing staff will contact you and conduct a phone interview to assess how we may best serve your specific needs. We can help you decide whether you are a suitable candidate for Mohs, whether you will require plastic surgery repair of your defect, and whether IV sedation anesthesia will be required. We will also review your skin cancer biopsy results and can expedite your referral to a qualified Mohs specialist.
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