Upper Margin of the Forehead Flap and Its Correlation With Aesthetic Results in Nasal Reconstruction in Fitzpatrick Skin Type III and IV Chinese

Abstract

BACKGROUNDThe forehead flap is one of the most commonly used methods for nose reconstruction. OBJECTIVE To determine the ideal upper margin of the flap in nasal reconstruction and its correlation with aesthetic results. METHODS From April 2013 to September 2017, 40 patients underwent nasal reconstruction involving the dorsum with a forehead flap. The authors hypothesized 5fdifferent levels as the position to place the upper margin of the forehead flap: (1) glabella, (2) level of the upper eyelid, (3) intercanthal line, (4) horizontal line between the keystone and intercanthal line, and (5) the keystone. Then they photoshopped the upper margins of the forehead flap at 5 different levels and designed a questionnaire. Nasal reconstructive plastic surgeons, medical practitioners, and people without medical backgrounds chose the most aesthetically pleasing photograph for every patient. RESULTS The questionnaire showed that the most aesthetically pleasing positions were located at glabella (n 5 0), level of upper eyelid (n 5 9), intercanthal line (n 5 24), the line between keystone and intercanthal line (n 5 6), and keystone (n 5 1). CONCLUSION The authors suggest placing the upper margin of the forehead flap at the level of the intercanthal line in nasal reconstruction involving the dorsum to achieve the best aesthetic results.

Alar Crease Creation Suture in Nasal Reconstruction

“…4 These principles include dividing the nasal surface into topographic subunits based on adjacent topographic areas with characteristic skin quality, border outline, and three-dimensional contours. [4][5][6][7][8][9]14 The alar groove represents a unique subunit in which a mildly convex surface of the alar rim and alar sidewall meets an extremely concave surface of the alar groove, just medial to the junction of the cheek. 15 It deepens as it extends laterally and seems to be more defined in black and Asian people than in Caucasian people.…”