Nasal reconstruction in darker skin: is the subunit principle valid?

Authors

  • Badr M. I. Abdulrauf Department of Plastic Surgery, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20203057

Keywords:

Facial, Nasal, Aesthetic, Skin, Dark, Complexion

Abstract

The subunit principle of aesthetic nasal reconstruction is well known among reconstructive surgeons and it is considered to be the excellence of care. It advocates to reconstruct a nasal defect as per the specific subunit, placing the suture line at a border of one subunit and its adjacent within the nasal surface. Individuals with skin types III to V are prone to hyperpigmentation, hypertrophic scars, keloids and obvious suture marks. Applying the subunit principle in these darker complexion patients would not be sufficient. In fact, it would result in a scarred nose with a patch. With our frequent experience in such cases, it was very important to revisit the mentioned principle. In darker complexion individuals requiring significant part of their nose to be reconstructed, a consideration should be given to entire nasal unit reconstruction. This would allow placing the seams at junction with adjacent regions (cheek and lip) rather than within the nose and much acceptable aesthetic outcome.

Author Biography

Badr M. I. Abdulrauf, Department of Plastic Surgery, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia

I AM A RECONSTRUCTIVE PLASTIC SURGEON , WITH CLOSE TO 20 YEARS OF PARCTICE IN A TERTIARY CARE SETTING.  RESIDENCY TRAINING PROGRAM DIRECTOR, CAHIRMAN BOARDS EXAM COMMITTE.

 HAD MY EDUCATION, TRAINING IN CANADA.

AREAS OF INTEREST/ EXPERTISE ARE HEAD AND NECK ANATOMY/ H&N SURGERY/ PAEDIATRIC RECONSTRUCTIVE SURGERY/ FACIAL SURGERY.

References

Gonzalez-Ulloa M, Castillo A, Stevens E. Preliminary study of the total restoration of the facial skin. Plast Reconstr Surg. 1954;13:151.

Gonzalez-Ulloa M. Restoration of the face covering by means of selected skin in regional aesthetic units. Br J Plast Surg. 1956;9:212.

Millard DR. Reconstructive rhinoplasty for the lower two thirds of the nose. Plast Reconstr Surg. 1976;57:722.

Burget GC, Menick FJ. The subunit principle in nasal reconstruction. Plast Reconstr Surg. 1985;76:239-47.

Fitzpatrick TB, Seiji M, Gugan MAD. Melanin pigmentation. New England J Med. 1961;265:274-8.

Morgan JE, Gilchrest B, Goldwyn RM. Skin pigmentation. Current Concepts Relevance Plastic Surg. 1975;56:617-82.

Converse JM, McCarthy JG. The scalping flap revisited. Clin Plast Surg. 1981;8:413.

Chang HY, Chang CS, Zelken J. Aesthetic refinements in forehead flap reconstruction of the Asian nose. Plastic Surg. 2017;25(2):71-7.

Singh DJ, Bartlett SP. Aesthetic considerations in nasal reconstruction and role of modified nasal subunits. Plast Reconstr Surg. 2003;3(2):639-48.

Hackler F, Jelks G, Persing J, Pribaz J. Facial defects after Moh’s surgery and trauma: Options for reconstruction. Presented at the 17th Annual meeting of northern society of plastic surgeons, in Montreal Canada, September 2000.

Downloads

Published

2020-07-22

Issue

Section

Case Series