Use of the nasal SMAS to reconstruct defects of the tip, alae, columella, or septum

Reconstruction using traditional methods for small and medium-sized losses of the soft tissues of the lower third of the nose, including the tip, the columella, alae, or the cartilaginous septum, has meant leaving cicatricial stigmata surrounding the region and has required at least two operational stages. A comprehensive study of the local anatomy was completed, and a specific technique (presented herein) was used to transfer and distribute the well-vascularized layer of superficial muscle and aponeurotic tissue (SMAS) from the dorsum of the nose to the needed site, which provided bulk and a well-nourished surface that could be covered by a distant skin graft, using a one-step flap. The surgical approach to the SMAS was carried out through the scar over the site of tissue loss or through the site of regional ablation or the traumatic wound. Several representative cases are presented.