Aesthetic reconstruction of the tip of the nose

The nasal tip is a thin structure, often just 3 or 4 mm thick. There is little need to inform an audience of Mohs histographic surgeons that as a defect becomes progressively deeper it goes in the space of a few short millimeters from superficial to full-thickness perforation. Tissue defects of little significance to the structure and aesthetics of the nose (and requiring a simple solution) can at first glance look the same as defects of great significance. Attainment of the aesthetic result, rather than a merely reparative one, requires that the wound be analyzed anatomically and three-dimensionally, tissues be replaced in like kind, the wound be braced with a lamina of cartilage (or bone), the internal hard tissue framework be given a refined aesthetic shape (at Stage II), and the mantle of carefully selected donor skin and subcutaneous fat be a work of sartorial excellence.