title: Practical details of nasal reconstruction.
abstract: OBJECTIVE
  Learning Objectives: After reading this article, the participant should be able to: 1. Examine a nasal defect to determine its true dimension and outline and plan the appropriate timing of reconstruction. 2. Develop a surgical plan to restore normal dimension, volume, symmetry, and outline. 3. Determine the need for local versus regional flap repair. 4. Understand and apply aesthetic principles of nasal reconstruction. 5. Use exact surgical templates to determine the position, dimension, and outline transferred tissues. 6. Distinguish the indications for a two- or three-stage forehead flap. 7. Use the modified folded forehead flap technique with primary and delayed primary support replacement. 8. Understand an approach to the late revision.
  
  
  CONCLUSIONS
  This article and accompanying video discuss a step-by-step approach to the reconstruction of a full-thickness heminasal defect in a demanding attractive woman who developed necrosis after cosmetic rejuvenation of the nasolabial fold by filler injection. Aesthetic principles were applied to develop a surgical plan to define the timing of reconstruction and true defect for repair with a full-thickness folded forehead flap transferred in three stages using a modified folded forehead flap for lining and primary and delayed primary support with a late revision to further refine nasal landmarks.
authors.affiliation: Tucson, Ariz. From private practice.
authors.forename: Frederick J
authors.initials: FJ
authors.lastname: Menick
mesh_terms: D003357:Cosmetic Techniques / Q000009:adverse effects; D005260:Female; D006801:Humans; D009336:Necrosis / Q000209:etiology / Q000601:surgery; D009666:Nose / Q000473:pathology / Q000601:surgery; D012225:Rhinoplasty / Q000379:methods*; D013524:Surgical Flaps
references.citation: Menick FJ. The evolution of lining in nasal reconstruction. Clin Plast Surg. 2009;36:421–441.
references.citation: Burget GC, Menick FJ. Nasal support and lining: The marriage of beauty and blood supply. Plast Reconstr Surg. 1989;84:189–202.
references.citation: Menick FJ, Salibian A. Microvascular repair of heminasal, subtotal, and total defects with a folded radial forearm flap and a full-thickness forehead flap. Plast Reconstr Surg. 2011;127:637–651.
references.citation: Menick FJ. An approach to the late revision of a failed nasal reconstruction. Plast Reconstr Surg. 2011;129:92e–103e.