Revising or redoing an imperfect or failed nasal reconstruction

Almost all major nasal reconstructions will require a late revision to refine aesthetics and function. The early surgical result after pedicle division will be determined by the materials, methods, priorities, planning, and surgical stages chosen by the surgeon. Imperfections in nasal contour, including recreation of the alar crease and nasolabial fold, are corrected by soft tissue debulking and secondary cartilage grafting through peripheral or direct incisions. The nostrils are enlarged by soft tissue excision and local tissue rearrangement. Occasionally, the original repair must be discarded and a second regional flap used to "redo" the reconstruction. Success is determined by careful analysis of the visual deformity, regional principles of the subunit reconstruction, and careful planning.