Utilizing a Curved, Perialar Advancement Flap to Maximize Esthetic Outcomes in Nasal Reconstructions

Abstract

Introduction: The closure of distal nasal sidewall defects greater than 1 cm has traditionally engendered limited reconstructive options. Because the defects are too large for primary closure and because skin grafting frequently yields suboptimal esthetics, flap reconstructions are commonly employed. For these, many surgeons tend to rely on either the bilobed flap or the larger Rieger dorsal nasal rotation flap. However, while these reconstructions yield excellent results, none of their suture lines are hidden in any natural creases. Objective: The objective of this article is to present the authors' experience in using a nasal advancement flap they frequently use in their practice that has an added advantage of camouflaging a large portion of its suture lines within the alar crease to enhance cosmesis. Methods: The authors review their results with 10 patients who, after Mohs micrographic surgery, were left with distal nasal sidewall defects and underwent reconstruction using the curvilinear perialar crescentic advancement flap. Results: All patients demonstrated excellent cosmetic outcome without pin cushioning deformities or tenting at the junction of the cheek and nose cosmetic subunits. There was no alar distortion, and all patients were satisfied with the esthetic outcome. Conclusion: The curvilinear perialar advancement technique is an excellent alternative to other commonly used nasal sidewall closures such as the bilobed double transposition and the Rieger flap and can effectively complement the reconstructive armamentarium of any reconstructive surgeon.