In Beverly Hills and serving the Los Angeles area
The nose is the focal point of the face. Trauma or skin cancer can result in significant nasal deformities that require full nasal reconstruction. Dr. Azizzadeh is the director of The Institute for Rhinoplasty and Nasal Reconstruction and has significant expertise and experience in complete nasal reconstruction as a result of previous nasal trauma or skin cancer following MOHS skin cancer surgery. Dr. Azizzadeh will work with your dermatosurgeon who performs most of these surgeries in order for you to obtain the best possible reconstructive outcome.
During your consultation with Dr. Azizzadeh at The Institute for Rhinoplasty and Nasal Reconstruction in Beverly Hills, California, Dr. Azizzadeh will first proceed with analyzing your nasal defect. Dr. Azizzadeh will utilize imaging, diagrams, and illustrations to identify the core problem of your nasal defect. Typically, the nose is divided into aesthetic subunits for nasal reconstruction. The aesthetic subunits include the roof of the nose, the sidewall of the nose, the tip of the nose, the nostrils, and the soft triangle between the tip of the nose and the nostrils. Each subunit needs to be evaluated separately and collectively with the rest of the nose, face and cheek. Once the defect has been recognized a surgical algorithm will be utilized.
For small defects, typically a very small local flap such as a bilobed rotational flap can suffice in the reconstructions. Skin graft and cartilage graft with advanced rhinoplasty techniques will be utilized to not only allow excellent aesthetic outcome, but also functional outcome so that the nose maintains it structural support that would allow for better breathing and lack of collapse of the nose in the long-term period. Other types of reconstructive measures for small defects include primary closure, skin grafts as well as a cheek flap that would replace the nasal sidewall with a cheek tissue.
For larger defects the nasal reconstruction may necessitate tissue from the forehead area that will be used to reconstruct the nose in a multiple stage procedure. Again cartilage grafts and internal lining will be utilized to create optimal aesthetic outcome. The forehead skin is the most similar skin to the nasal skin and therefore is often utilized for larger defects by Dr. Azizzadeh in his Los Angeles based Institute for Rhinoplasty and Nasal Reconstruction. The paramedian forehead flap is based on an artery and therefore has excellent blood supply. This provides the best possible aesthetic outcome for larger nasal defects. Cartilage graft for a major nasal reconstruction can be obtained from the patient’s septum, ear, or rib area. Cartilage grafts are extremely important in the process of nasal reconstruction. They provide a foundation for the nose which is absolutely necessary to obtain the best aesthetic and functional outcome for the nose.
Other types of nasal reconstructions may be related to major nasal trauma, cleft lip nasal deformity or a significantly botched rhinoplasty that has resulted in collapse and disfiguration of the nose. The approach to these types of nasal deformities is to again consider functional and breathing issues as well as aesthetic concerns. Often times the nostrils are asymmetric, there is significant saddle nose deformity and collapse of the nasal bridge. Cartilage deformities can have formed that will cause the nose to completely collapse. For these types of issues Dr. Azizzadeh utilizes a multi-step algorithm to correct the nasal dorsum (bridge of the nose as well as the nasal tip and nostrils). For the nasal dorsum, Dr. Azizzadeh will often require grafts from the ear, septum and/or rib to reconstruct and straighten the nose. This provides excellent support of the nasal dorsum. Spreader grafts, which are cartilage grafts that are placed in the middle portion of the nose, are utilized to maintain internal support for breathing capacity of the patient. Oftentimes, maneuvers of the tip, nostril and the nasal tip cartilages are necessary to re-symmetrize the nose and improve the nasal breathing passageway. Often times excess skin is required, for a significantly botched nose, that can be harvested through the columellar skin graft for the forehead skin. Nasal reconstruction is perhaps the most challenging operation in all of plastic surgery and as a result requires detailed discussions and considerations. Please review the before and after photographs of major nasal reconstructive procedures performed by Dr. Azizzadeh at The Institute for Rhinoplasty and Nasal Reconstruction.
Before and After Primary Rhinoplasty:
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