Understanding Nasal Reconstructive Surgery
Surgery to reconstruct the nose may be required following removal of cancer, trauma, or for congenital (birth) defects. The goal of nasal reconstruction is to restore both the form and function of the nose. The 3-dimensional structure of the nose is formed by three main layers: the inner lining tissue, the middle structural support comprised of bone and cartilage, and the outer covering tissue (skin). Each of these layers may need to be reconstructed depending on the location, size, shape, and depth of the nasal defect or deformity. In some cases, other surrounding areas of the face including the cheeks, eyelids, or upper lip may also be involved and require reconstruction.
Understanding the Surgery
Your surgeon may use a variety of surgical techniques to reconstruct the nose depending on the location, size, shape, and depth of the nasal defect or deformity including:
- Secondary-intention healing
- Skin grafts
- Local flaps
- Regional flaps (cheek or forehead flaps)
- Cartilage grafts
Each of these techniques has advantages and disadvantages, and multiple techniques may be used in combination in some cases. Small defects can often be reconstructed in a single surgery in the office or operating room under local anesthesia or under light sedation. Large defects involving multiple layers of the nose or larger areas of the nose may require a staged approach with multiple surgeries over the course of several weeks under general anesthesia. Additionally, in these cases, additional cartilage may need to be taken from the nasal septum, ears, or ribs in order to help support the nasal reconstruction and provide a structural framework for the reconstruction.
What to Expect After Surgery
Recovery following nasal reconstruction will be dependent on the specific techniques that were used. For smaller defects that are reconstructed with local flaps, skin grafts, or suture closer, the initial recovery period may range from 1-2 weeks. Sutures are typically removed between 5-7 days after surgery. The incisions will initially appear red and raised, and they should gradually fade and flatten out over a period of weeks to months. In general, scars will typically “mature” over the course of one year. Most patients undergoing reconstructive procedures for smaller defects that involve only a small area of the nose can typically resume most normal activities within 10-14 days after surgery. On the other hand, larger reconstructive procedures involving the use of cheek or forehead flaps may proceed in a staged fashion over a period of 3-8 weeks. In these scenarios, patients may have a period of time where the flap remains attached to the nose, resulting in a temporary deformity that may limit a patient’s comfort from being seen by others. Additionally, depending on the technique used, there may be temporary obstruction of the nasal airway, making it more difficult to breathe through the nose. In some cases, minor revision or touch-up procedures can be performed several months after the initial reconstruction to help improve the overall aesthetics of the nose.