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Nasal Reconstruction

Babak Azizzadeh, MD, FACS is internationally recognized for his expertise in facial plastic surgery and nasal reconstruction. His Harvard-trained expertise in aesthetic and reconstructive rhinoplasty surgery attracts patients both nationally and internationally to the CENTER for Advanced Facial Plastic Surgery in Beverly Hills. He is the author of five bestselling books, including Master Techniques in Rhinoplasty and Beverly Hills Beauty Secrets, is recognized as a Top Doctor by the US News & World Report, and has been featured on the Oprah Winfrey Show, The Doctors, The New York Times, and countless other media outlets.

What is Nasal Reconstruction?

Nasal reconstruction is most often needed after skin cancer, accidents, nasal collapse, or trauma to the nose, to name a few. To help such patients recover with minimal nasal deformity, Dr. Azizzadeh leads a team of plastic surgeons and otolaryngologists to provide some of the most advanced nasal reconstruction results available.

The field of nasal reconstruction has seen significant advances in recent years, and Dr. Azizzadeh has been gone to great lengths to remain on top of the surgical curve. In fact, he has been a contributing member to this elite community, researching and finding new techniques to help patients find relief after skin cancer or nasal trauma. He is a recognized and respected member of this field, by both patients and peers alike.

In addition to board certification in Facial Plastic & Reconstructive Surgery, Dr. Babak Azizzadeh is board certified in Otolaryngology—Head and Neck Surgery. This gives him a complete understanding of underlying structures in the head. In performing surgery on the nose, this knowledge is crucial to giving his patients the best surgical outcomes possible while maintaining the integrity of their nasal function. Further, this knowledge allows him to perform complex nasal reconstruction to restore smooth breathing if that function has been lost.

Dr. Azizzadeh’s Approach to Reconstructive Nose Surgery

In approaching nasal reconstruction, Dr. Azizzadeh upholds four concepts when approaching this type of surgery:

1. Listen to the Patient

As a first priority, Dr. Azizzadeh listens to the patient discuss their concerns and goals for surgery. He further gathers data from his patients about what lead to the need for nasal reconstruction (whether it be as a result of an accident, previous health problems, congenital, etc), allowing him to cater his surgical methods to their exact needs. After a thorough discussion, Dr. Azizzadeh takes a graduated approach to nasal reconstruction, first considering the least invasive methods possible to address the defect.

2. Anatomy of the Face

A second major concept in nasal reconstruction is the basic anatomy of the face. Because the face is comprised of 3-dimensional anatomy (like “peaks and valleys”), each of these areas must be treated as a separate unit. Incision placement is key, never crossing from one of these areas into another. This is particularly important in nasal reconstruction because the 3-D curvatures, form and anatomy must be preserved.

3. Tissue Replacement

The third concept in addressing nasal defects is the importance of replacing tissue with tissue of a very similar structure and type. Each layer of the nose has varying types of tissue, and reconstruction cannot be fully successful unless these are replaced with tissue of similar properties. In nasal reconstruction, grafts are sometimes used from other parts of the body, and Dr. Azizzadeh is careful to only harvest grafts that are appropriate for their new placement.

4. Preservation of Nasal Function

The fourth and final concept is the preservation of nasal function during reconstruction. The nose and sinuses are complex structures, requiring a thorough knowledge of how they work. While Dr. Azizzadeh strives for an optimal aesthetic outcome, he also uses the full extent of his expertise to ensure each patient retains maximum nasal function.

Providing an excellent outcome, both aesthetically and functionally, is of paramount concern to Dr. Azizzadeh. His goal is for patients to be able to return to their normal daily activities without any aesthetic deficits.

Am I A Good Candidate for Nasal Reconstruction?

In deciding whether to have cosmetic surgery, patients should examine many factors that extend beyond the surgery itself.

Learn more

Comprehensive Nasal Reconstruction Consultation Process

A nasal reconstruction consultation with Dr. Azizzadeh is a unique experience. He spends as much time as necessary getting to know the patient, understanding his or her cosmetic and functional objectives. From there, he can perform examinations to discover the underlying issues with the nose that have created cosmetic and functional deformities. Additionally, he will examine the anatomy of the entire face, including the lips and chin, as these features have a direct impact on how the nose is perceived. With all these factors in place, Dr. Azizzadeh can determine the best possible approach to help each patient get the nose he or she desires.

For the cosmetic aspect of nasal reconstruction, Dr. Azizzadeh uses a specialized imaging system called the Vectra. This system takes 3D photographs of the patient’s face, allowing examination of all necessary angles. Further, with the Vectra software, Dr. Azizzadeh can alter the appearance of your nose right on the screen. This is enormously helpful in reaching an agreement regarding your treatment plan, as it allows for images, not just words, to convey the expected outcome.

During a rhinoplasty consultation for nasal reconstruction, Dr. Azizzadeh will examine each of the following areas to gather both cosmetic and functional information regarding the nose:

  • Age
  • Ethnicity
  • Skin thickness
  • Profile
  • Frontal appearance of the nose
  • Nasal tip and base
  • Relationship between nose and lips
  • Relationship between nose and the cheeks, chin, forehead and eyebrows
  • History of trauma to the nose
  • Entire breathing system, including the septum, valves, turbinates, sinus disease and allergies

As a highly specialized facial plastic surgeon, Dr. Azizzadeh takes the time necessary to help his patients fully understand their cosmetic options during their rhinoplasty consultation. He educates patients on the underlying causes of their cosmetic or functional complaints, along with how each treatment option will address those particular issues. In the complex field of facial plastic and reconstructive surgery, knowledge is the most important thing for a patient, and that is Dr. Azizzadeh’s primary goal. From there, he knows that you will make the right decision for yourself.

Since many patients from around the world come to Beverly Hills to have nasal reconstruction with Dr. Azizzadeh, he also offers Skype rhinoplasty consultations.

Nasal Reconstruction Recovery Information

Following nasal reconstruction, the recovery process is critical in achieving a beautiful and functional result. At our office, we will provide you with a comprehensive list of post-surgical guidelines. We’ve included some of these guidelines below, giving you an idea of what you can expect:

  • Clean your incisions with hydrogen peroxide once a day.
  • Use antibiotic salves on incisions and just inside the nostrils twice a day.
  • Cold compresses or frozen peas should be placed gently over the eyes and cheeks for the first three days following surgery. After three days, use a warm compress on areas that have persistent bruising.
  • Keep head elevated for at least one week following surgery. This includes while you sleep, rest or relax.
  • No rigorous exercise for three weeks after surgery.

At The CENTER for Advanced Facial Plastic Surgery, our goal is your comfortable, smooth recovery. If any questions or concerns arise at any point during your nasal reconstruction recovery, we are at your disposal. Please call or email us with any questions and we will help with anything you need.

Nasal Reconstruction Case Study

A 67-year-old man needed nasal reconstruction surgery after undergoing complex MOHS surgery to removal basal cell carcinoma at the junction of the right ala and cheek.

The defect measured approximately 7 x 5 cm and involved the right cheek, upper lip and nasal regions (right lateral sidewall, ala, soft triangle, and tip subunits). Luckily, the patient's facial nerve was still intact.

For this patient's defect, a 3-stage operation was used to achieve optimal nasal reconstruction results. Dr. Azizzadeh used the paramedian forehead flap technique because it is a very reliable reconstructive option.

Stage 1

In the first stage, the cheek and upper lip defects were reconstructed with cheek advancement flaps because the patient had ample facial skin redundancy. By advancing the cheek tissue to the border of the lateral nasal wall and cheek subunits, the subunit principle was taken into account. Extreme care was taken to prevent the upward traction of the upper lip, which would have resulted in both aesthetic and functional deficits.

Then the full-thickness nasal defect is reconstructed in a multilayered fashion, treating like with like tissue. The internal lining is reconstructed with a vascularized contralateral septal-mucosal flap. The cartilaginous framework was reconstructed with septal and auricular cartilage, and the external skin was restored with a vascularized paramedian forehead flap. The forehead flap skin tissue most resembles nasal skin and is best for major nasal reconstruction. Extreme care was taken to restore an appropriate middle nasal vault and right nostril curvature to avoid collapse of the newly formed internal and external nasal valves.

Stage 2

The second stage of the nasal reconstruction operation was performed 3 weeks after the first surgery. At this time, the paramedian forehead flap, while still attached to its supratrochlear pedicle, was aggressively thinned. This maneuver allowed Dr. Azizzadeh to obtain a final outcome that best recreates the natural contours and topography of the nose. An overly thick forehead flap will obliterate the curvatures of the 3-dimensional cartilage framework that is crucial in restoring the various nasal subunits. The vascular pedicle was maintained to prevent necrosis of the distal tissues.

Stage 3

The final stage of the operation involved sectioning the paramedian forehead flap pedicle. The left upper lip was also lifted at this stage to improve the upper lip aesthetics. This stage was performed 3 weeks after the second stage.

Trust Your Face To An Expert

As an internationally renowned facial plastic and reconstructive surgeon, Dr. Azizzadeh has been featured in major news outlets for his unrelenting expertise in this crucial field. Most notably, he was featured on Oprah for his groundbreaking facial nerve reconstruction on Mary Jo Buttafuoco, a prominent shooting victim.

Additionally, Dr. Azizzadeh has been featured in People Magazine, New York Times, Discovery Health, Los Angeles Times, Beverly Hills Courier, and many other prestigious media outlets. He authored the best-selling book Beverly Hills Beauty Secrets, and was the lead editor on a number of definitive medical textbooks, including Master Techniques in Facial Rejuvenation and Master Techniques in Blepharoplasty and Periorbital Rejuvenation. These textbooks have become a standard in the medical community and are used all over the world by board-certified plastic surgeons as well as training programs for up and coming plastic surgeons. He is the co-director of the annual, world-renowned Cedars-Sinai Advances in Multispecialty Aesthetic and Reconstructive Surgery Symposium and the co-director of the USC Facial Plastic Surgery Fellowship Program.

Schedule a Consultation

If you are in need of nasal reconstruction, your next step is a consultation with Dr. Azizzadeh. As a premier facial plastic and reconstructive surgeon, he approaches nasal reconstruction with the intention of providing both functional and aesthetic results that help each patient thrive. For out of town patients, we offer Skype consultations. To get started on your rhinoplasty surgery, please call our office and set an appointment.

Schedule Your Consultation Today Call (310) 657-2203

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