Nasal reconstruction.

The face tells the world who we are and materially influences what we can become. The nose is a primary feature. Thin, supple cover and lining are shaped by a middle layer of bone and cartilage support to create its characteristic skin quality, border outline, and three-dimensional contour. The delicacy of its tissues, its central projecting location, and the need to reestablish both a normal appearance and functional breathing make its reconstruction difficult. Nasal repair requires careful analysis of the anatomical and aesthetic deficiencies. Because the wound does not accurately reflect the tissue deficiency, the repair is determined by the "normal." A preliminary operation may be required to ensure clear margins, recreate the defect, reestablish a stable nasal platform on which to build the nose, and prepare tissues for transfer. Major nasal defects require resurfacing with forehead tissue; support with septal, ear, or rib grafts; and replacement of missing lining. This requires a staged approach.