There are many types of unattractive noses, and total rhinoplasty can help individuals achieve a completely new, beautiful nose. So, is total rhinoplasty a good option? Regarding this question, let our experts explain the merits of total rhinoplasty below.
1. Lining Tissue Issues: In cases of extensive nasal defects or total nasal loss, the nasal tip, columella, and alar soft tissues suffer varying degrees of destruction, leading to defects in the nasal mucosa. During reconstruction, these defects must be addressed. If free skin grafts are used within transferred flaps, subsequent graft contracture may compromise the reconstructed nose's appearance.In recent years, scar flaps from the nasal dorsum or nasolabial fold flaps have been increasingly used to reconstruct the alar or columellar lining. This step prevents postoperative contracture of the transferred flap and creates a well-vascularized recipient site for the flap. The latter is crucial for flap survival.Without an adequately vascularized recipient bed, the transferred flap may undergo necrosis. Should this occur, subsequent repair becomes extremely challenging. When inverting nasal dorsum tissue flaps or scar flaps downward, careful preservation of the pedicle's blood supply is essential. Excessive dissection must be avoided, as it may cause necrosis at the distal end of the inverted flap, compromising the graft's viability.
2. Surgical Design of the Transfer Flap: The transfer flap must be designed appropriately, neither too large nor too small. An excessively large flap results in an overly bulky reconstructed nose, while an overly small flap creates excessive tension, leading to vascular compromise and necrosis at the distal end.The optimal approach involves designing the flap intraoperatively using cloth or paper templates. Preliminary estimates can be made preoperatively. Typically, the transferred flap measures approximately 6–7 cm in length, with a lower segment width of 6.5–7.5 cm. The alar width is 1.5 cm, while the columellar width is 2.0 cm with a length of 1.5–2.0 cm. The flap should exhibit a trifoliate configuration.
3. Surgical Support Issues: Traumatic nasal defects often involve damage to the nasal bone and septum, necessitating reconstruction of the nasal framework during reconstruction. Common approaches include rib cartilage grafting or silicone implant placement. Based on our experience, performing this during the second-stage surgery is preferable. By this point, the flap has established adequate blood supply, making implant placement safer.