Reconstructive surgery of the nose is a correction of deformities and defects as a result of trauma,
cleft lip and palate repair, congenital anomalies, or after previous surgeries such as tumor surgery or a cosmetic procedure.
Nose reconstruction entails restoring or preserving the functional aspects of the nose, as well as the aesthetics. Reconstructive Surgery of the nose is an appropriate treatment choice for patients who were suffering from a traumatic injury to the face, with a nasal fracture, who are suffering from skin cancer or other tumors of the nose, who are suffering from a congenital anomaly, or who have undergone previous rhinoplasty (cosmetic) procedures. It is easy to imagine that reconstructing the nose (either partial or total), is an intricate process based on its multilayered anatomic structure of this complex functional organ, which is at the center of the face. Normal appearance and function are, and need to be, treatment goals. Reconstruction of the nose contributes to regain quality of life, making a patient able to socially interact with greater ease, and hopefully to be able to enjoy life again.
Reconstruction of the nose is commonly performed as a result of skin cancer or other tumor treatments. It is amazing what can be accomplished surgically, even when the internal structures (ie, septum, cartilage, mucosa) are affected, damaged or lost. Patients come to seek the help of a plastic surgeon, directly, or possibly by being referred by their doctor who made the diagnosis of skin cancer with the intention that the plastic surgeon excise and reconstruct the defect. Some patients, also come, in a delayed fashion, after the initial excision having already been performed to get the defect reconstructed.
You may have been recently diagnosed with skin cancer of your nose, or you may suspect a suspicious skin lesion. No matter if the diagnoses has been made by your dermatologist, a biopsy has been taken or an excision has been performed already, Dr Bianca Knoll and her team will be able to start or to continue the surgical treatment of your skin cancer. Covering a resulting nasal defect after skin cancer, is ideally preferred using local flaps from the surrounding area matching in skin color and thickness and therefor leading to a more aesthetic results compared to skin grafts or regional flaps. The incision lines are planned to be in natural creases and respecting the aesthetic subunits of the nose.
SIMPLE Nose reconstruction, that is covering a skin defect alone, caused by excision of a skin tumor is most elegantly achieved by moving adjacent (nose, cheek, forehead) tissue into the defect and placing the scars into natural skin folds (boundaries of normal aesthetic units). Skin grafts are technically much easier to perform, but are usually much more visible and may have color, and thickness discrepancies related to the surrounding tissue.
This requires a thorough and mindful surgical plan, how the adjacent skin can be moved to cover the defect without trading off one deformity for another. Local flaps are advantageous, since when skillfully performed the incisions, color and thickness of the skin will blend in nicely. The safety margin of removing skin cancer differs from the 3 most common types of skin cancer: basal cell carcinoma, squamous cell carcinoma, and melanoma. The treatment of those 3 most common types differs from each other also depending on their histological stage.
COMPLEX Nose reconstruction is a multiple staged process that involves using excess skin from adjacent areas. The incision lines are well hidden in natural creases or so-called “lines of minimal tension”. Cartilage from your nose, ear or even your rib in special cases may be used to reconstruct the internal nasal framework.
It is possible to restore and reconstruct almost every part of the nose by restoring boundaries of the aesthetic units (specific regions of the nose with defined boundaries) and the principles of aesthetic plastic surgery.
Nasal deformities and nasal airway reconstruction may result after nasal/facial fractures, even if they had been treated previously. The incidence of secondary nasal deformities after nasal trauma have been reported in high percentages.
Before undergoing corrective surgery to establish the nasal airway and aesthetic shape of the nose a comprehensive evaluation of the nasal airway is essential.
A challenging situation in cosmetic surgery is correcting the “operated– done look“ developed as a result of previous surgeries of the nose. Although, all changes may not be “undone” completely, at least some and hopefully significant improvement is achievable. This is somewhat dependent on how and what previous surgery was performed. Secondary rhinoplasty procedures may follow “primary rhinoplasty “ when the results of the first (or multiple previous) surgery (ies) are not what the patient wishes. Secondary rhinoplasties are somewhat more involved, in that the recognition and reshaping of tissue requires more internal support and construction due to the presence of scar tissue. Additional tissue, usually cartilage form either the nose, ear or the rib may be needed internally to correct the structural, functional and aesthetic deficits of the previously operated nose. The success of a rhinoplasty procedure is clearly dependent on the meticulous planning and skilled surgical performance of your surgery. Most of the rhinoplasty procedures can be performed safely in an ambulatory setting. Depending on your general health, length and type of nose reconstruction procedure or revision rhinoplasty, and your personal comfort an overnight stay in the hospital might be necessary. Dr Knoll and her staff will be happy to provide you with further information about the procedure and answer your questions during your consultation in the Frankfurt office. Dr Bianca Knoll will be happy to discuss the possibilities of you nasal reconstruction / revision rhinoplasty that may be specific for your individual circumstance during your office visit.
Given the different causes requiring a nose reconstruction procedure, it is quiet difficult to provide any estimated costs of a nose reconstruction without having examined and talked to the patient. It is easy to understand that the costs of the surgery will vary depending on the complexity, length of the procedure, hospital stay, and the details involved. Usually there are 3 different costs associated with a surgery; the surgeon’s fee, hospital fee, and anesthesia fee. In some nose reconstruction cases the procedure might be fully or partially covered by your health insurance. Costs related to revision rhinoplasties whose initial surgery was a cosmetic procedure, is not covered by health care insurances.During your office consultation with Dr. Knoll you will be thoroughly examined, allowing us to provide you with information pertaining to surgery, post operative expectations and cost associated with your individual surgery plan. For these reasons a consultation in our Frankfurt office is strongly encouraged. We understand that it can be impractical for some of our out of town / or international patients to travel to Frankfurt for an initial consultation. For this reason, Dr. Knoll offers online consultations. By submitting a series of photographs, information about your desired outcome, and a little about yourself, we can start to determine if you are a good candidate. Though a virtual consultation starts the consultation conversation, it does have it’s limitations and does not replace the need to be seen in person for a traditional consultation to finalize plans for a procedure.
We understand, that considering another surgical procedure / nose reconstruction can be psychologically very challenging to patients. During your consultation Dr Knoll will carefully listen to your concerns, examine you and thoroughly analyze your facial features. She will then discuss this with you, and explain your available options. You can be confident that Dr. Knoll will be honest about realistic expectations, obtainable results, potential risk and benefits associated with an additional rhinoplasty procedure. In some cases a preoperative CT-scan or additional functional studies of your nose might be required. If you have already had some of these tests performed, please bring a copy with you to your consultation. Old operative reports are also very helpful. Some patients opt also to send those medical documents to us, prior to their consultation appointment. The more information Dr Knoll has about your previous procedures, the more conclusive your consultation will be. Medical photographs will be performed during your consultation. You will also receive further information about any type of preoperative testing required and additional information about the procedure.Choosing an experienced plastic surgeon who has performed nose reconstructions, rhinoplasties, and craniofacial surgery using modern and advanced techniques is important. If you wish to have additional information or would like to schedule a consultation please contact the office of Dr. Bianca Knoll, we will be happy to assist you.