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Reconstructive surgery of the nose after cancer (basal cell carcinoma, squamous cell carcinoma, melanoma) or trauma

The goal of nose reconstruction is to restore nasal shape and function. It is a facial reconstruction surgery procedure.

Reconstructive surgery of the nose may be necessary in various situations:

  • Fractures of the nasal pyramid
  • Nasal anomalies due to trauma
  • Treatment of skin cancers (basal cell carcinoma, etc.)
  • Collapse of the nasal septum due to drug addiction
  • Congenital respiratory discomfort

Nasal fracture repair is the most common form of nasal repair. In most cases, the repair can be performed within days of the accident. Sometimes, treatment of a broken nose is performed in a delayed fashion. Delayed treatment is similar to a rhinoplasty.

Treatment of nasal skin cancer can result in losses of substance that are small and superficial or massive and full thickness and will affect respiratory function.

This medical information sheet was written in June 2021 by Dr Ralph ABBOU who is a plastic surgeon specializing in nose surgery and rhinoplasty in Paris.

Dr Ralph ABBOU defended his medical thesis on the subject of rhinoplasty and has published several scientific publications on this subject. 

Dr Ralph ABBOU participates in several congresses per year in France and abroad in order to maintain and perfect his theoretical and technical skills.

Before and after nose job photos in Paris

What is a carcinoma ?

A carcinoma is a malignant tumor of the skin or cancer. There are two types of carcinomas:

  • squamous cell carcinoma or squamous cell carcinoma that can cause cancerous metastasis
  • basal cell carcinomas which do not cause metastasis.

How to recognize a carcinoma?

The diagnosis is most often made by your dermatologist who has detected a lesion of the epidermis after skin examination or who has palpated a nodular tumor under the skin because the symptoms are very variable and can be discrete.

Sun exposure is a risk factor.

The diagnosis of certainty is based on skin biopsy and anatomopathological examination.

How is carcinoma treated?

  • For basal cell carcinomas, there is no metastasis. Treatment is based exclusively on surgery, i.e. removal of the lesion.
  • For squamous cell carcinomas and melanomas, the treatment is more complex and can combine surgery, radiotherapy, chemotherapy during a multidisciplinary management between dermatologist, oncologist, radiologist and surgeon.

How to operate on the nose after cancer?

The first step is to definitively treat the lesion surgically. 

Once the disease has been ruled out and after having received histological evidence (anatomical pathological examination), reconstruction can be envisaged serenely.

Reconstruction of the nose after cancer requires the restoration of :

  • the inner mucosa 
  • the cartilaginous or bony framework
  • the external skin.
  • The tip of the nose
  • the wing of the nose

A variety of techniques may be required to repair nasal tissue loss secondary to cancer:

  • skin grafts
  • skin flaps 
  • forehead flaps: forehead flap
  • nasolabial flaps
  • cartilage grafts

Course of the nose reconstruction

  • First, the loss of substance is examined to understand what is anatomically missing: skin, cartilage or bone, and nasal mucosa.
  • Then, we use the contralateral or unaffected side’s nasal properties as a guide for repair.
  • Then the “normal” facial part is used as a model to reconstruct the missing part. The missing parts of the skin, cartilage support and mucosa are replaced and reshaped to approximate the appearance of the normal nose.  

The goal is to restore a normal appearance. Careful planning, aesthetic principles, and modern methods can usually produce good results.

One or more operations are necessary to achieve a satisfactory result.

The operating time and the length of the postoperative period depend on the complexity of the reconstruction.

If you live outside of Paris or outside of France, you can send us pictures or schedule a teleconsultation, we will be able to help and advise you remotely.

Anesthesia for nose reconstruction

The repair of a small loss of substance on the nose requires a local anesthetic. More complex treatments require sedation or general anesthesia in the operating room.

Forehead flap to reconstruct the nose

A forehead flap is a two-stage surgical procedure to repair loss of substance of the lower nose.

In the first step, a flap of skin from the forehead that matches the dimensions of the nasal defect is transferred to the nose to cover the defect.

The blood supply for the flap is maintained from a tissue bridge connected to the forehead.

In the second step, the bridge connecting the nose to the forehead is removed and the incisions are completely closed. This is a technique for reconstructing complex nasal tissue loss.

Nasolabial flap to reconstruct the nose

Nasolabial flaps are ideal for repairing loss of nasal skin in the nostril area. Fold skin extending from the corner of the nose to the corner of the mouth is transferred to fill the loss of substance.

Dr. Abbou has published a nasal flap reconstruction technique (original reconstruction technique).

Bilobed flap to reconstruct the nose

The bilobed flap is a surgical procedure that repairs a loss of substance of the nose by transferring tissue from an adjacent site and closing the newly formed defect in the donor area with a second, smaller flap. Bilobed flaps are particularly useful in the reconstruction of nasal defects less than 1 cm in width.

Ear or rib cartilage for nasal reconstruction

Nasal septal cartilage can be used to replace destroyed or missing cartilage in nasal reconstruction. In the absence of adequate cartilage in the septum, cartilage can be harvested from the external ear or rib without functional or cosmetic sequelae.

What is rhinophyma?

Rhinophyma is an excessive thickening of the skin in the lower part of the nose due to a chronic skin infection: rosacea. The result is a progressive enlargement and deformation of the tip of the nose. Treatment involves controlling the infection and surgically removing the excess skin at the tip of the nose.

Price of a nose job after cancer

Starting at 300 euros.

The price of nose reconstruction varies according to the complexity of your case and the number of procedures required.

Nose surgery is covered by social security or health insurance and by your health insurance company.

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