The nose performs numerous functions and is one of the main defining features of the face. Congenital deformities, trauma, and previous surgery can all cause both external and internal issues which can be corrected with with nasal reconstruction. Dr. Trussler has significant experience treating these complex nasal problems and will take his time to explain the reconstructive plan that is right for you.
What Are My Options?
The approach to nasal reconstruction involves the correction of both form and function of the nose. The nose functions as both a sensory organ and a regulator of air flow. Nasal reconstruction should preserve these functions and in some cases improve function.
Correction of the nasal airway through addressing areas of obstruction can help improve the function of the nose.
- Septoplasty: straightens the deviation of the nasal septum.
- Internal and External Nasal Valve Surgery: enlarges the nasal airway.
- Turbinate Ablation: reduces the size of the turbinates.
Trauma and previous surgery, such as the removal of skin cancer (Moh’s Surgery), can alter the form of the nose. Nasal reconstruction can help to straighten the congenital or post-traumatic crooked nose, or it can close open areas left after Moh’s surgery.
Nasal reconstruction is performed on men and women over the age of 16 when the nose has reached maturity. Ideally, nasal reconstruction should be performed on healthy individuals with complaints of nasal dysfunction after trauma or from a congenital deformity. Nasal reconstruction after Moh’s surgery depends on the size of the defect and the location on the nose. Dr. Trussler will listen to your goals and evaluate your nose to determine the best reconstructive method to correct nasal form and function.
The nose is made up of multiple components, including bone, cartilage, mucosal lining and skin. Nasal reconstruction is approached through the correction of each component as needed. Correction of the nose after trauma or from congenital deformities commonly focuses on the realignment of bone, the straightening of cartilage, and release of scar. Secondary refinements may be required after one year is needed.
The complete removal of the cancerous lesion of the nose is the main goal of Moh’s surgery. The nasal reconstructive goals after Moh’s surgery is the closure or coverage of the open defect with the maintenance of form and function. In the reconstructive process there may be more incisions and/or donor sites created to harvest the tissue used for closure. These incisions will form scars which will heal and fade over time. Additional procedures may be needed such as scar revisions, flap division and inset, and scar care after the area of Moh’s surgery is healed.
Nasal Reconstruction is usually an outpatient procedure performed under general anesthesia. The nose is very sensitive and in order for Dr. Trussler to perform precise and complex nasal procedures the patient needs to be comfortable.
Dr. Trussler uses one of two techniques when performing nasal surgery after trauma (broken nose) or for congenital defects. In a closed reconstructive technique, incisions are made within the nostrils. In an open technique, the incision is made across the columella, the tissue between the nostrils. With both methods, Dr. Trussler gently lifts the soft tissues covering the nose and then sculpts the bone and cartilage to correct shape and improve the airway. If the patient does have a deviated septum, Dr. Trussler will adjust the septum and the inner structures of the nose to improve breathing. The tissues are replaced over the nose and stitched closed. If the patient desires nostril reshaping, this is done as the final stage of rhinoplasty.The entire procedure generally lasts just over two hours.
Nasal Reconstruction After Moh’s Surgery
Straight line closure: brings the two edges of the open wound together creating a straight-line scar. Typically used for smaller defects on the bridge of the nose.
Rotational flap: brings tissue beside the open defect over to cover the open wound. This typically requires another incision so that the adjacent tissue can be rotated. Used for the dorsum and side of the nose.
Pedicled flap: brings tissue from another area close to the open wound on a “leash” of blood vessels and skin so that the living flap of skin can be transferred a larger distance to cover the area. Used for moderate defects on the tip and nostril area of the nose.
Skin graft: a partial thickness or full thickness piece of skin is taken from another area called a “donor site” and then placed on the open area of Moh’s surgery. This skin graft adheres to the open wound and survives as a skin covering to defect.
Composite graft: is similar to a full thickness skin graft but also includes a layer of fat which all adheres to the wound to cover and fill the open area. Can be used to close small areas on the nasal tip.
Free tissue transfer: skin, muscle and/or bone are taken from a donor site on the body and then transplanted by suturing the blood vessels of the flap to blood vessels near the open wound using an operative microscope. The “free flap” is living, growing tissue used to cover large and complex areas of Moh’s surgery, typically used to reconstruct the entire surface of the nose.
After Care & Recovery
Recovery from nasal reconstruction depends on the type of treatment performed.
For a short time after surgery, patients may experience puffiness, nose ache or a dull headache, some swelling and bruising, bleeding or stuffiness. Most patients feel like themselves within two days and return to work in about a week. Dr. Trussler does place a nasal splint on the nose and silicone splints in the nose in the surgery for nasal deviation. All splints and stitches are removed in one week. Normal activity can be resumed in 3 weeks.
The results of nasal reconstruction become gradually apparent as the days pass after surgery and swelling recedes. Swelling may reappear from time to time in the first year after the procedure. It is typically more noticeable in the morning and fades during the day. Contact lenses can be worn immediately, but glasses may need to be taped to your forehead or propped on your cheeks for up to seven weeks to avoid pressure on the nose and nasal bones.
Scar care will be started at the three week point after surgery to help fade scars. Dermabrasion and laser resurfacing may be needed to help flatten the areas of reconstruction. Revision procedures and flap divisions may usually be considered at the three week to three month point after surgery, however scars will typically take about one year to fully mature and fade. Patients with realistic goals for nasal reconstruction are generally very happy with the new shape of their nose and this can be appreciated almost immediately. The exact results depend on the patient’s nasal bone and cartilage structure, facial shape, skin thickness and age.
Dr. Trussler will provide patients with specific after care instructions in order to facilitate proper healing and successful results.
- Heller JB, Gabbay JS, Trussler AP, Heller MM, Bradley JP. Repair of Large Nasal Septal Perforations Using Facial Artery Musculomucosal (F AMM) Flap. Annals of Plastic Surgery. 55(5):456-459, November 2005.
- Janis JE, Trussler AP, Ghavami A, Marin V, Rohrich RJ, Gunter JP. The Lower Lateral Crural Turnover Flap. Plast Reconstr Surg. 2009 Jun;123(6):1830-41.
Whether you have a question or would like to setup a nasal reconstruction consultation, Dr. Trussler and his staff are here to help. Please fill out our contact form, or call our office at 512-450-1077 to schedule an appointment. Start your journey to not only looking, but feeling better today!