Noel W, Duron J B, Jabbour S, Rem K, Bertrand B, Quilichini J, Revol M, Mazouz Dorval S
Plastic and Reconstructive Surgery Department of Hôpital Saint Joseph, 185 Rue Raymond Losserand, 75014 Paris, France.
Plastic and Reconstructive Surgery Department of Hôpital Saint Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France.
J Plast Reconstr Aesthet Surg. 2017 Aug;70(8):1112-1117. doi: 10.1016/j.bjps.2017.02.012. Epub 2017 Feb 27.
Defects involving several aesthetic subunits (ASUs) or lying at the junction of an ASU are challenging and require a complex reconstruction. This study aimed to describe the hemi-tip as a new ASU.
We conducted a retrospective study including patients who underwent a nasal reconstruction for lower nasal pyramid defects according to our modified ASU principle. Patients who suffered from a subtotal alar defect, which also involved <50% of the tip, were reconstructed after excising the remaining tissue of the hemi-tip subunit. An aesthetic evaluation was performed using a patient satisfaction scale and by independent raters.
From 2010 to 2014, 21 patients underwent a lower hemi-nose reconstruction. All patients had a full-thickness defect and underwent a reconstruction of the three layers of the nose. Sixty-four percent of our patients were very satisfied, 26% were satisfied, and only 10% were unsatisfied with their nasal tip appearance, with a mean score of 4.4/5. The nasal tip was also rated by independent raters with a mean score of 4.1/5.
Our results and experience showed that a midline scar between the two hemi-tips is inconspicuous. The majority of the defects involving only one side of the tip would benefit from the hemi-tip ASU reconstruction.
We have modified the number of ASUs by considering the hemi-tip as a proper subunit.
