The nose, as the central part of a person’s face, is a crucial element of our identity and self-esteem. It can be finicky to reconstruct because it is a delicate, three dimensional structure that does not donate much extra skin. This week, I am finishing the third stage of a nose reconstruction surgery. Why does it take three surgeries?
My patient underwent a forehead flap where a portion of the forehead is brought down to resurface the nose. We have to give the body enough time to allow the blood supply of its new home to grow into the flap before it is separated from the forehead. In the second surgery, the flap is thinned to allow the shape of the nose to show through. In the third stage, the flap is finally separated from the forehead.
The nose is also made up of nine aesthetic subunits. The edges of these subunits are helpful to use as places to hide the lines of scars. We can be mindful of these subunits when planning how tissue which is moved around will change its shape and contour as it heals.