[Challenge of total nasal reconstruction]

The complete reconstruction of a nose with good function and inconspicuous appearance is a very demanding task. This article outlines the current state of the art, which has evolved with increasing demands on esthetics. Skin expansion enables sufficient hairless skin to be obtained and minimizes harvesting defects. The increased use of radial forearm flaps enables good results even with larger defects. An additional intermediate step before dividing the pedicle helps to optimize the function and appearance. The basic principles remain unchanged: reconstruction in three layers with a framework made of autologous rib cartilage and a skin layer that covers the entire esthetic unit of the nose with a forehead flap. Nowadays, a complete reconstruction usually involves 5 procedures within about 8 months. A case study illustrates the central aspects of neorhinoplasty in all steps. Complications and unplanned revisions form the conclusion.