Esthetic Nasal Reconstruction Using Forehead Flap

BACKGROUND: 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. OBJECTIVE: 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. METHOD: Four patients who underwent forehead flap reconstruction with different etiologies were presented, highlighting the features of each reconstruction. RESULTS: 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. CONCLUSION: 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.