title: Should we consider the hemi-tip as a proper aesthetic subunit in a nasal reconstruction?
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  We have modified the number of ASUs by considering the hemi-tip as a proper subunit.
authors.affiliation: Plastic and Reconstructive Surgery Department of Hôpital Saint Joseph, 185 Rue Raymond Losserand, 75014 Paris, France. Electronic address: warren_noel@hotmail.com.
authors.forename: W
authors.initials: W
authors.lastname: Noel
authors.affiliation: Plastic and Reconstructive Surgery Department of Hôpital Saint Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France.
authors.forename: J B
authors.initials: JB
authors.lastname: Duron
authors.affiliation: Plastic and Reconstructive Surgery Department of Hôpital Saint Joseph, 185 Rue Raymond Losserand, 75014 Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Jabbour
authors.affiliation: Plastic and Reconstructive Surgery Department of Hôpital Saint Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France.
authors.forename: K
authors.initials: K
authors.lastname: Rem
authors.affiliation: Plastic and Reconstructive Department of Hôpital la Conception, 147 Boulevard Baille, 13005 Marseille, France.
authors.forename: B
authors.initials: B
authors.lastname: Bertrand
authors.affiliation: Plastic and Reconstructive Surgery Department of Hôpital Robert Ballanger, Boulevard Robert Ballanger, 93600 Aulnay-sous-Bois, France; Department of Plastic Surgery, Avicenne Hospital, Paris XIII Medical School, Bobigny, France.
authors.forename: J
authors.initials: J
authors.lastname: Quilichini
authors.affiliation: Plastic and Reconstructive Surgery Department of Hôpital Saint Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Revol
authors.affiliation: Plastic and Reconstructive Surgery Department of Hôpital Saint Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Mazouz Dorval
mesh_terms: D004954:Esthetics; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009667:Nose Deformities, Acquired / Q000601:surgery*; D017060:Patient Satisfaction; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000379:methods*
keywords: Aesthetic subunit; Lining; Nasal reconstruction; Reconstructive surgery