Esthetic Nasal Reconstruction Using Forehead Flap

The paramedian forehead flap is the workhorse flap for major nasal defects involving multiple subunits and the lower third of the nose. Although the principles of soft-tissue envelope design are well described, a comprehensive, 3-dimensional conceptual framework to guide individualized reconstructive planning remains insufficiently articulated.

The aims were to present an algorithmic approach to 3-dimensional reconstruction, discussing the skin and soft tissue, bony and cartilaginous foundation, and lining, and to assess the aesthetic form and function of multilayered reconstruction.

Four patients who underwent forehead flap reconstruction with different etiologies were presented, highlighting the features of each reconstruction.

In addition to restoration of form and function, there was 100% patient satisfaction, with no loss of reconstruction over an average follow-up period of 19.5 months.

The success of forehead flap reconstruction relies on a comprehensive top-down and outside-in reconstruction of the nose. Considering the etiology, a patient-specific approach to graft selection and the timing of flap division will allow surgeons to achieve optimal functional and aesthetic outcomes in reconstructing major rhinoplasty defects.