Management of Small Nasal Defects

Repair of nasal defects has always been a great challenge for facial plastic surgeons. Because of heterogeneity of the nasal skin and being composed of different subunits, nasal reconstructive attempts are of great concern. In order to understand the underlying arguments of nasal reconstruction, first of all, we will briefly revise the anatomic structures of the nose. The nose is composed of nine subunits including the dorsum, sidewall, ala, tip, soft triangle, and columella. Moreover, it consists of three main layers: (i) outermost layer, (ii) cartilage and bony framework, and (iii) inner lining. The outermost layer of the nose is skin and considered together with supporting subcutaneous tissue and muscles of the nose. The second layer is composed of cartilaginous and bony framework, namely, uppermost part of quadrangular cartilage, upper and lower lateral cartilages, nasal bones, and part of maxilla. In the innermost layer, the mucoperichondrium/periosteum and skin of nasal vestibule are present. The defect in each layer should be evaluated separately and can be managed with any of single-step or multistep procedures. Either surgical technique ranging from primary closure, secondary intention, and skin grafting to local/regional skin flaps should provide the tissue characteristics such as texture, thickness, color, aging patterns, and tendency of hypo-/hyperpigmentation and nasal contouring similar to original nasal skin.