"How I do it"--plastic surgery: practical suggestions on facial plastic surgery. Surgical excision and primary reconstruction of a moderate size tumor involving the nasal tip and dorsum.

A moderate size tumor of the nasal tip and dorsum is excised and the large defect is primarily reconstructed with local flaps without obliteration of natural convexities and concavities. This is achieved by judicious utilization of numerous techniques. The techniques utilized are a V to Y advancement that produce a partial mobilization of the nasal dorsal skin, a full reduction rhinoplasty that dropped the nasal bony roof allowing for further mobilization of the nasal dorsal skin and allowed for tip elevation. A third technique that was utilized was a Z plasty as applied to correction of raised webs. The excess dorsal skin was converted into the needed length to close the tip defect. The patient tolerated this procedure well. His postoperative course was without complications. Postoperative results were good, but there was some persistent tip elevation that perhaps gave him a too youthful appearance for his age (Fig. 2). A novel use of V to Y advancement, Z plasty, and reduction rhinoplasty is described when used concurrently to primarily close a defect of the nasal tip and dorsum.