The nose is vital for proper breathing and is the central feature of your facial appearance. When it is damaged, it can cause sinus problems, breathing difficulties and flawed balance to your face. Dr. Gary Linkov at City Facial Plastics is a respected facial plastic and reconstructive surgeon. He can restore beauty and function to your nose if it is damaged due to trauma.
Restoring the nasal structure is a complex reconstructive procedure that must embody both functions and form for excellent results. Dr. Linkov has spent years helping those with facial trauma recover the function and form of their facial features, including the nose. Using advanced techniques and cutting-edge medical technology, he can restore the function of the nasal passages and ensure the balance and aesthetics of the nose appearance.
Nose Trauma Repair
A blunt force trauma to the nose during a motor vehicle accident, sports injury or other incidents can leave the nasal passages collapsed and the nose disfigured. In some cases, the nose is damaged due to surgical removal of skin cancer or other medical procedures. Dr. Linkov can restore lost cartilage and skin to rebuild the shape of the nose. His goal is always to allow for proper function while retaining a pleasing appearance to the nose and facial balance.
All cosmetic nose alterations require extensive expertise, whether it is an aesthetic nose job or due to trauma. To ensure you receive the best care for both nasal form and function, you can trust Dr. Linkov for superior results if you need nasal reconstructive surgery.
If you have suffered a nose injury that has altered the function and appearance, contact City Facial Plastics in New York City. We can schedule a consultation with Dr. Linkov to discuss options for nasal reconstruction to improve the look and function of your nose after a facial injury.
What is nose reconstruction?
Nasal reconstruction involves restoring areas that have been damaged or removed. A few basic principles guide the surgeon in performing nose reconstruction, including:
- Replace like with like – This refers to using the same type of tissue to replace lost tissue. An example is replacing skin on the tip of the nose with adjacent skin if possible to provide a color and thickness match.
- Aesthetic units – The nose can be subdivided into subunits which are used to guide reconstruction. If 50% or more of a subunit is affected, often the remainder of the subunit is removed and the entire subunit replaced.
- Reconstructive ladder – There is a stepwise process to nasal reconstruction that should be followed when deciding which type of reconstruction to do. It starts with a simple solution, such as letting the area heal on its own (secondary intention), and works up to more and more advanced flap procedures.
Who is a good candidate for nose reconstruction?
There are various indications for nasal reconstruction, such as:
- Cancer – After skin cancers like basal cell carcinoma and squamous cell carcinoma on the nose are removed, the defect is closed with a nose reconstruction.
- Trauma – Various nasal injuries may require reconstruction. Often the initial goals are to close any obvious lacerations and irrigate the wounds. The nose reconstruction may be planned in a delayed fashion if needed.
- Congenital defect – Cleft lip patients sometimes have nasal deformities that may require correction. Conditions such as nasal dermoid cyst also often require nasal reconstruction once the lesion is removed.
What is the relevant anatomy for nose reconstruction?
The nose consists of three main structural components relevant to reconstruction. These include:
- Skin – The outer layer of the nose which is composed of skin that is thin and loose closer to the upper bridge, and thick and adherent by the tip.
- Cartilage – The majority of the visible nose keeps its shape due to the cartilage that lies beneath.
- Mucosa (inner skin) – The inner lining of the nose is called the mucosa and is important for nasal breathing and air filtration.
As per one of the central principles explained above, it is important to replace all missing layers with its analogous tissue.
Knowing the nine nasal aesthetic units also helps in planning a nasal reconstruction. These include:
- Dorsum (bridge)
- Paired sidewalls
- Paired alae
- Paired soft tissue triangles
As a general rule, if at least 50% of a subunit is affected then the remainder of that subunit is removed and the entire subunit reconstructed. This is done to create the ideal aesthetic outcome and a nasal appearance that does not draw attention to it.
How is nose reconstruction done?
There are different options available to the surgeon for nasal reconstruction. These depend on surgical skill set, surgeon preference, size and extent of defect, and patient preference and medical condition. The majority of nose reconstructions are done under general anesthesia but can be performed under local anesthesia or deep sedation in certain instances. The general categories of nose reconstruction options include:
- Secondary intention healing – Wound closes gradually by itself which can be a prolonged process but is the simplest form of repair.
- Primary intention – Suture closure which is a great option for smaller defects on the nose where the surrounding tissue will not distort.
- Skin graft – Removed from another area such as the back of the ear, skin can be placed over the nose defect and bolstered in place until it heals in. This can result in depression and discoloration.
- Local flap – Tissue adjacent to the nasal wound can be rearranged, advanced, or rotated to fill the defect. Incisions are placed in ways to camouflage the repair.
- Regional flap – Tissue not immediately next to the nasal defect can be recruited for closure, such as from the cheek or forehead. These surgeries sometimes require more than one procedure to complete the nasal reconstruction.
- Cartilage/bone graft – These tissues may be needed to provide added support if cartilage or bone are missing. Often ear cartilage is used to help reconstruct the nasal ala. Rib cartilage or septal cartilage can also be applied.
- Alloplastic material – Large nasal defects with significant loss of structural support may require a combination of treatments which at times include various foreign materials to serve as a scaffold.
What is the recovery from nose reconstruction?
The recovery after nose reconstruction will depend on the exact type of reconstruction employed. Swelling, bruising, light bleeding, and pain can be expected in the first 1-2 weeks. Patients should apply antibiotic ointment to the incisions and/or bolsters during at least the first week to prevent infection and to keep the incision sites from drying out. At the first follow up appointment at 1 week postoperatively, the skin sutures are removed (if not dissolvable), and bolsters are removed if they were used.
The nose is a complex structure made of many components. It serves an important role in the way we look and is responsible for nasal breathing. There are times when the nose is damaged and needs to be repaired. Reconstruction of the nose may be necessary after a trauma, removal of cancer, or a congenital defect. Nasal reconstruction has become more elegant with better breathing and appearance results over the past few decades.
Larger regional flap reconstructions may require additional staged procedures and patients may experience difficulty breathing through the nose and/or a cosmetic deformity between procedures. Incisions will appear red for weeks to months and the final scar is judged at one year. Scar revision is possible, at least 3 months after nasal reconstructive surgery, and laser resurfacing or dermabrasion may be started as early as 6 weeks after surgery if indicated.
What are the risks and complications of nose reconstruction?
The possible risks of nasal reconstruction include:
- Unfavorable cosmetic outcome
- Poor scarring
- Nasal breathing difficulty
- Nasal valve collapse
- Prolonged healing
How much does nose reconstruction cost?
Most cases of nasal reconstruction are covered by insurance as they are rarely done for purely cosmetic reasons. However, some patients may not have insurance coverage and some surgeons may not accept in-network insurance. In these situations, a cost that includes the surgeon’s fee, facility fee, and anesthesia fee is calculated based on the complexity of the nasal reconstruction and number of anticipated stages.
Who is the best nasal reconstruction surgeon in NYC?
Dr. Gary Linkov is a board-certified facial plastic surgeon in NYC specializing in the best nasal reconstruction. Dr. Linkov is the best specialist with extensive experience treating all conditions of the nose. He is the Chief of Otolaryngology and Facial Plastic Surgery for the Veterans Hospital in Brooklyn, NY, where he operates on complex nasal deformities on our country’s veterans. Dr. Linkov’s private practice in NYC focuses on nasal reconstruction, as well as cosmetic and functional rhinoplasty.