Aesthetic refinements in use of forehead for nasal reconstruction: the paramedian forehead flap.

Historically, surgeons have avoided use of the forehead for nose reconstruction because they felt larger areas of tissue were required. As plastic surgery has evolved to achieve successful replacement of major nasal defects, the paramedian forehead flap has been refined as the best alternative. Judicious use of central forehead tissue will provide sufficient skin of excellent tint to allow total repair. Scars are almost always unobtrusive. The forehead flap covers fabricated composite flaps of intravasal lining and primary cartilage grafts that create the subsurface architecture of the external nose. The result is a nose with correct shape and color that appears normal.