What Is Nose Reconstruction?
Nose reconstruction surgery after cancer is usually performed in order to restore the shape and appearance of the nose following removal of either a skin cancer or an internal cancerous tumor. This type of procedure is typically more involved than regular rhinoplasty, as it may require replacing various tissues lost from the excision.
Depending on the type of cancer that’s been removed and the amount of tissue loss, rhinoplasty surgeon Dr. Rizk will determine which technique will be most suitable for the reconstruction. This could include using tissues from other parts of the body (such as the rib), or using a reconstructive technique such as a skin flap, bone graft, cartilage graft, facial implant or fat transfer to replace missing tissue.
In addition to considering what type of surgery needs to be performed, Dr. Rizk will also consider the patient’s aesthetic goals and desired outcome. He understands that a person’s nose is often their most prominent facial feature, and as such takes extra care to ensure it is reconstructed to look natural and aesthetically pleasing.
Removal of Skin Cancer and Tumors
Typically, if a skin cancer needs to be removed from the nose, that surgery is performed by a dermatologist. However, for best cosmetic results, the dermatologist should work in tandem with a plastic surgeon, such as Dr. Sam Rizk, whose practice consists of 10-15 percent reconstructive surgery after either cancer removal or trauma to the face and nose.
Dr. Rizk’s nose reconstruction procedures are coordinated with the dermatologist ahead of time, which means that you can undergo the reconstruction on the same day as the excision. The excision is performed by the dermatologist and the patient is sent over to Dr. Sam Rizk’s center for the reconstruction.
Here are some examples of nose excision procedures that will need Dr. Rizk’s care and attention for the nose reconstruction:
Mohs Excision | Plastic Surgery After Mohs on Nose
Skin cancers are referred to Dr. Sam Rizk typically after a MOHS excision is done by a dermatologist. A MOHS excision is a micrographic excision intended to preserve normal tissue by examining and mapping surgical borders under the microscope. Dr. Rizk is experienced in reconstructing the external nose after a skin cancer removal.
Removal of Basal Cell Carcinoma (BCC)
BCC typically grows slowly, but it may require multiple stages of reconstruction in order to restore the nose and its function.
Squamous Cell Carcinoma (SCC)
SCC is a more dangerous type of skin cancer, and it can spread to other parts of the body if not treated. Dr. Rizk is experienced in restoring form and function to the nose following SCC excision.
Malignant Melanoma
Malignant melanomas require a more comprehensive approach to reconstruction, as they can have significant effects on the surrounding tissue and may need to be reconstructed in several stages.
Benign Tumors | Hemangiomas and Nasal Polyps
Benign tumors such as hemangiomas may or may not require surgical excision, and nasal polyps can also be removed surgically.
Wide Local Excision | Removal of Internal Nose Cancers
The amount of tissue damage depends on the size and location of the tumor as well as how much normal tissue needs to be removed. Sometimes the tumor is in the wall that separates the two sides of the nasal cavity (the nasal septum). In these situations, the surgeon might need to remove part or all of the nasal septum. Dr. Rizk is experienced in reconstructing the internal nose after wide local excision of an internal cancerous tumor.
Removal of Part or All of Your Nose
For cancers on the side of the nose affecting the skin, your surgeon can usually remove the affected part. Doctors call this operation a partial rhinectomy. Your surgeon may need to remove all of your nose if the cancer has spread widely into your nose tissue. This operation is called a total rhinectomy.
More on Rhinoplasty
- Revision Rhinoplasty
- Skin Care After Rhinoplasty
- Ethnic Rhinoplasty
- Septoplasty & Sinus Surgery
- Finesse Rhinoplasty
Nose Reconstruction After Cancer Removal
The best approach for the reconstruction will depend on the size and location of the area to be reconstructed and any specific individual needs that a patient may have. The goal is always to restore as much of the original nasal structure as possible so that patients can regain their confidence and feel comfortable again with their appearance. There are several techniques used during a rhinoplasty procedure, depending on what type of reconstruction is needed.
Localized Tissue Flaps | The Preferred Option
The local flap technique involves taking tissue from another area near the nose, such as the forehead, and using it to reconstruct the nose. This technique is often used when only a small portion of the nose needs to be reconstructed or replaced. This may take the form of a flap where tissue is rotated into the defect, advanced into the defect or moved into the defect using a combination of rotation and advancement. The advantage of this technique is that it doesn’t require the use of a skin graft, and it also preserves much of the patient’s existing tissue.
Skin and Cartilage Grafting | Not Enough Local Tissue Available
When local tissue flaps from surrounding tissue aren’t enough to rebuild the nose, skin grafts can be used. Skin grafts involve taking skin from another area of the body, such as the thigh, and attaching it to the nose. The cartilage graft involves taking cartilage from another part of the body, such as the ear, and using it to rebuild the nose. A composite graft is composed of skin and cartilage (usually harvested from the patient’s ear) and this is also an option.
Major Grafting | Collapsed Nasal Bridge Reconstruction
Sometimes in major cancer reconstructions additional rib (costal) cartilage from a tissue bank and temporalis fascia (soft tissue obtained from above patient’s ear) may be used to build a collapsed nasal bridge from cancer removal. If internal nasal structures have been removed due to cancer, the nose can collapse due to loss of support and in severe cases Dr. Rizk recommends the use of costal (rib) cartilage from a tissue bank, to build the collapsed structures which may involve the nasal tip, bridge, or both.
Forehead Flap Surgery as Last Resort
The amount of tissue damage depends on the size and location of the tumor as well as how much normal tissue needs to be removed. Sometimes the tumor is in the wall that separates the two sides of the nasal cavity (the nasal septum). In these situations, the surgeon might need to remove part or all of the nasal septum. Dr. Rizk is experienced in reconstructing the internal nose after wide local excision of an internal cancerous tumor.
The Recovery Process
After surgery, patients usually stay in the hospital for a few days before returning home, where they will have to take it easy and avoid strenuous activity. Swelling and bruising around the eyes and nose is expected, while normal activities can usually be resumed after 8 weeks.
The recovery process takes time as the new nose must heal properly; however, with Dr. Rizk’s expertise, most of his patients are thrilled with their results. The healing process is different for each person, and scarring also depends on how well the body heals. After surgery, you should follow all post-surgical instructions to ensure optimal results.
Asymmetry Correction and Scar Tissue Reduction After Reconstruction
Asymmetry is often a problem after rhinoplasty surgery, whether it be from an injury, prior surgery or due to the removal of skin cancer. Dr. Rizk strives for perfection and works diligently to achieve the best results for each patient. If you are unhappy with your appearance after reconstruction, Dr. Rizk may be able to use a combination of forehead flap, cavitary reconstruction and other techniques to correct any asymmetry.
Cosmetic Rhinoplasty
When using skin from other parts of the face to reconstruct the nose, the result may create some asymmetry as the skin of the face is thicker than that of the nose. After a year has passed from the initial nasal reconstruction, some patients may elect to do a cosmetic rhinoplasty to correct the asymmetry. Cosmetic rhinoplasty would involve debulking or thinning out the thicker tissue that was transferred to the nose from surrounding tissue.
Laser Treatments
Laser treatment can help to improve the appearance of scars on the nose. By using a fractional laser, Dr. Rizk can break down scar tissue and stimulate collagen production to improve the appearance of scars. However, patients should be aware that results may vary depending on how the body heals from surgery. Scars may be decreased with Dr. Rizk through the use of either a fractionated CO2 laser, microdermabrasion or both.
Reduction of Scar Tissue Impeding Breathing
Some intranasal functional surgery may be performed to remove bulky tissue/scar tissue which may be blocking the patient’s breathing. This can be performed sooner than a year if an internal deformity or scar tissue is visible to improve the patient’s quality of life.
Final Thoughts
Nose reconstruction after cancer is a complex procedure that requires great skill and experience. Dr. Rizk has extensive experience in this area and his patients are delighted with their results. If you or a loved one has been affected by nasal or skin cancer on the nose, don’t hesitate to reach out to Dr. Rizk for a consultation today! He can provide the expertise needed to help restore your nose. Schedule a consultation with Dr. Sam Rizk Today!
Dr Rizk In The Media
Connolly Best Doctor
Dr. Rizk featured in Town & Country Magazine as one of the masters of the subtle lift and tweak that will turn back time
Voted by peers to New York Magazine’s 2013 Top Doctors
New Advances in Facelifting Techniques by Dr. Sam Rizk
Awards & Certifications
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By Dr. Sam S. Rizk, M.D., FACS.
Dr. Rizk is a double board-certified facial plastic surgeon who specializes in rhinoplasty surgery and a recognized expert on the latest advances in facial plastic surgery techniques. He performs a range of facial plastic surgeries at his New York practice.