I am deeply grateful and ever so appreciative of your truly welcome and much needed help! Your surgery results are nothing short of awesome! Thoughtfulness like yours indeed takes a special caring. Again, ‘Thanks a Million’ for everything!!
- P.B.S., Revision Rhinoplasty
I wonder how you create a living thing with your hands. How do you build something out of nothing? The thought of the task baffles me, but to my father, it is mundane.
- Katharine Searcy Menick click here for the rest of her perspective
I wanted to take a minute of your precious time to thank you and to let you know the true meaning of what you have restored in her. Yours is a truly special gift and the confidence in which you handled her case allowed her to focus on healing, not worrying!
- V.B., patient’s daughter Nasal Reconstruction
I feel great every time I look into the mirror. Thank you for that gift.
- C.G., Nasal Reconstruction
Needless to say, I am overjoyed at the acquisition of my new nose - something I never imagined I would need - turned out so splendidly. It is a wonderful gift that you bring the world with your expertise, your care, and your artistry. It replaces despair with hope and, indeed verges on the miraculous. My deepest thanks.
- D.L., Nasal Reconstruction - click here for case details
I think of you every time I look in the mirror and know how blessed I am to have you as my doctor – the genius….. Everyone tells me how beautiful I look and they are amazed at your ability. Thank you for making a nightmare experience quite pleasant and even fun at times…. We have so much to thank you for. You were beyond considerate and we are beyond grateful… I get compliments almost every day on my beautiful nose.
-J.D. Nasal Reconstruction - click here for case details
You are really a miracle worker! My nose is healing rapidly and I feel normal again - a delicious feeling.
- P.F., Nasal Reconstruction - click here for case details
I am so happy for getting the surgery. The surgery has changed the outlook I have about myself and my self-confidence. So thanks again because how can I repay someone who has changed my life.
- T.P., Revision Rhinoplasty after Congenital Nasal Hemangioma
You truly gave me a new lease on life, as the saying goes. My nose is absolutely beautiful; I still get compliments on it!
- D.W., Nasal Reconstruction/Revision
Thank you so much for taking such great care of our son. We couldn’t have made it through all this without your kindness and compassion.
- B. and G. S., Nasal Reconstruction for their child
Words will never be enough to express our gratitude for the work you have done with our daughter. You have made her a whole person again. From the first day we met you, we had unending hope for her. You plainly said you could fix her when everyone else warned us not to expect much.
- Mother of K.B. Facial Reconstruction - click here for case details
I would like to take this opportunity to tell you what a magnificent doctor and artist you are! My two surgeries a few months ago - nose repair and facelift - changed my life. Everyone remarks how beautiful the work is. I feel I have lived on both sides of appearance; that is, going from droopy and haggard to looking vibrant and pleasing.
- J.T., Facelift and Rhinoplasty - click here for case details
There is rarely a day that goes by that I don't Thank God for sending me your way. My nose is beautiful.
Magician performs excision: arm scar disappears!
- 6 word memoir dedicated to Dr. Menick by M.F. - click here for case details
We are back home...The result is fantastic and completely in line with the vision I had in mind. Thank you for understanding and making that vision a reality. The vastly significant improvement to my breathing will certainly enhance my overall health and quality of life as well. I have the best of both worlds in aesthetics and function. I am beyond happy and satisfied. Your staff is attentive, warm and caring.
- A.C., Revision Rhinoplasty
You restored my nose and therefore my face. You gave me back my identity, and allowed me for the first time in 26 years, to feel physically whole again. I could only begin to imagine how rewarding it must be to change and restore peoples' lives, getting back confidence, changing their outlook on life and making them ready to embrace life again as it was. Because of your surgical skills and the changes you made externally, I am feeling stronger internally...
- A.C., Revision Rhinoplasty
Thank you for giving me my identity back. While I could have lived with the scars from the dogbite, my psyche feels better knowing that I present the best face I can- with your help. Thanks for sharing the benefits of your skills with me. I am honored.
- M.T., Facial and Nasal Trauma after previous failed repair
I am thankful every day for what the Doctor was able to do for my daughter.
- D.L., Father of Nasal Trauma patient after previous failed repair
I hope you know deep in your heart how thankful I am for your skills. Let's call it a higher power that we met. I have no clue why things happen. However, I do know that our meeting each other and your willingness to come to my rescue was evident from the start. I just wanted you to know I was treated with great respect and care (kindness) which has continued to this day. I truly am a better man for having known you mentally and physically. From the bottom of my heart, thank you so very much...
- D.G., Facial and Nasal burn
I don't get on your side of town during working hours very often. I think in another month or so I will be over there and would just like to stop in real quick to shake your hand and thank you for my beautiful nose! Everything is going great. It gets better all the time.
- A.C., Nasal Reconstruction
Thank you very much for being brilliant, talented, and fun to be with. It was an amazing journey and the confidence Harper and I have in your skills made it easy to keep the Faith. We will never believe that we have said "Thank You" enough. God richly blessed our package of three, and it is important to include the hundreds of people that joined us in the long process. The kindness and helpfulness of Rachel and Tina your office staff.
- J.D., Nasal Reconstruction
I have been thinking of you and wondering how you are. My son will turn 18 soon and he is doing very well. His surgery all started with you and now he is almost grown! He wears a BAHA, a bone conducting hearing aid. I just want to say thank you for your very tender care of my son. His mom passed away nearly 4 years ago and I know she would join me in extending this thank you! You are a pretty decent ear maker too, and I would be willing to tell Dr. Brent!
- R.S., Father of Ear Reconstruction patient
I wanted to tell you how thankful I am that you worked on me today. I think it looks terrific! Your work must be so rewarding. You are life changing to so many. Thank you!
- K.D., Nasal Reconstruction
I just want to tell you and everyone else at the office, THANK YOU! You helped make my dreams come true with your patience and superb hospitality. I will be sure to tell all my friends how terrific this experience was for me. Thank you again very much!
- D.G., Rhinoplasty
I am deeply grateful and ever so appreciative of your truly welcome and much needed help! Your surgery results are nothing short of awesome! Thoughtfulness like yours indeed takes a special caring. Again, "Thanks a Million" for everything!!
- P.S., Revision Rhinoplasty
I wanted to thank you again for the great work that you did on my nose. My wife and I are very pleased. You are truly gifted. God bless.
- K.V., Nasal Reconstruction
Thank you for making a beautiful nose. I’ve always wanted a “normal” looking nose and without you I wouldn’t have had this life altering opportunity. You amaze me.
- L.S., Congenital Nasal Deformity Reconstruction
My nose is healing very well and it looks great. I must admit that I am really loving my new nose! Thank you very much Dr. Menick.
- C.M., Rhinoplasty
Your work is beautiful and so reminiscent of the Wabi Sabi concept but did you know that this advanced aesthetic concept is also a perspective and philosophy of life? Thanks for changing my life. I feel so vibrant and alive as a result of your work.
- A.C., Revision Rhinoplasty
Some gifts you hold in your hand: Some you hold in your heart. We are so grateful for the blessing of you! My family and I want to extend a sincere thank you for giving me my life back. You are a special man: Your heart heals us and your hands make us beautiful again. Dr. Menick, you create gifts like no other. No words could ever express the thankfulness I feel for you, your office staff and your hospital team...
- C.J., Nasal Reconstruction after Dogbite
Everything is going great and I have significant feeling in the nose. Once in a while certain vibrations (like singing) cause a most intense tickling/itching sensation. It’s kind of weird and exciting all at the same time. It gets better all the time. Thank you so much.
- A.C., Nasal Reconstruction
I am writing just to let you know that I am very happy with my nose now. It really changed my life a lot, now I can take lots of pictures of my face (it doesn’t matter if the light is in my face), it always looks great and I am very confident meeting people, I don’t have to hide anymore. I had some concerns about the high bridge but after 2 months I started being 100% happy. All the rib pain in the end was worth it. Thanks a lot for what you have done for me and I hope you will make many other patients happy.
- R.F., Revision Rhinoplasty
About Nasal Reconstruction
Human beings wish to look normal. Although normal breathing is vital, the primary function of the face and nose is to look normal. Anatomically, the nose is made up of an inner lining, a middle support layer of bone and cartilage, and an outer covering of skin which matches the face in color and texture. Aesthetically, plastic surgeons describe the nose in terms of units and subunits. These are characteristic areas of expected skin quality, border outline, and 3-dimensional contour which define what is a normal appearance. The nose is divided into the dorsum (bridge), the tip, the columella (the post between the nostrils), and bilateral ala (round subunits above each nostril rim), sidewalls, and soft triangles. Defects vary in site, size, shape, depth. They also vary in the anatomic layers injured (cover, lining, or support). However, The Normal does not change. The contralateral Normal – the other uninjured side of the nose or face – or the Ideal – is used as a guide to rebuild the Normal. There are many ways to close or heal a wound. Some patients are less motivated and prefer the simplest or fastest treatment, even if their appearance or function will be poor. Most patients wish their appearance to be restored to normal. Most patients are happy to invest more time and effort to restore the Normal, rather than just “getting it healed.”
Many of the Principles of modern Aesthetic Facial and Nasal Reconstruction techniques have been developed by Dr Menick.
Dr. Frederick J. Menick authored a comprehensive overview of nasal reconstruction on eMedicine, a web-based clinical reference guide. Learn more about Nasal Reconstruction, Paramedian Forehead Flap or about Rhinoplasty Tip Surgery
Click Here for Dr. Menick’s Nasal Reconstruction Gallery
Nasal Reconstruction Options
Simple Suture Closure
Because of the limited amount of extra skin on the nose, only small defects less than 4 – 5 mm in the upper nose can be sutured and closed without distorting the remaining tip or nostrils. Most nasal defects cannot be closed by simple suturing.
Secondary Intention Healing
If simply washed with soap and water, almost all wounds will slowly heal. The body sends in blood vessels and scar tissue (granulation tissue), which spontaneously fill the defect. Adjacent normal skin is stretched by the contracting scar myofibroblast, drawing normal skin inward and decreasing the size of the original wound. A superficial layer of skin cells grow over the scar, re-epithelializing the raw area. The final scar is usually flat and shiny. Temporary redness of healing fades away months later.
Secondary healing is used for small defects on the flat or concave surfaces of the nose. It is avoided near the convex tip or alar rim to prevent distorting the tip or nostril margins by scar contraction or the creation of a blunted or chopped off tip appearance.
A skin graft is a piece of skin that initially has no blood supply. When placed upon a vascular bed, during the first 24 hours, blood vessels from the recipient site reattach to the skin graft and permit the skin graft to “take” (revascularize). Skin grafts are most frequently taken from behind or in front of the ear, from the neck, or from the forehead. Skin grafts are usually used for small, superficial defects, which have a good vascular bed. Often, after cancer excision or trauma, the wound is not vascularized adequately to allow the immediate placement of a skin graft, so the defect is not repaired initially. The wound is allowed to begin spontaneous healing. New blood vessels grow into the area and the vascular bed improves over time. The skin graft is then applied a week or two later. This “delay” improves the “take” of the graft. Unfortunately, the color and texture of skin grafts are unpredictable and a graft can look too pale, too dark, or too shiny, and may not match adjacent normal skin of the nose. The usefulness of a skin graft is determined by the site, size, and depth of the defect. They can be quite effective, but may not restore a truly normal appearance. The goals of the patient and the limitations of skin grafts must be understood.
There is a only small amount of extra skin within the mobile skin of the upper nose. If the defect is small, the excess can be redistributed and shared from the remaining upper nose to cover a defect which lies within the inferior dorsum and tip. Although a scar remains, flaps usually have an excellent color and texture match, unlike skin grafts.
Local flaps, however, do not add skin to the nose. They simply “share” remaining skin around the nose. Because there is very little excess nasal skin, it is easy to distort the remaining nose. So local flaps should be used cautiously to avoid distortion of the tip or nostril margin due to excessive tension which may pull the residual parts of the nose into an abnormal position. Local flaps are best used when the defect is superficial and less than 1.5 cm in size.
Regional flaps move excess tissue from facial areas adjacent to the nose – the nasolabial fold (the loose skin just lateral to the lip and nose in the smile line) or from the forehead. Depending on the site, size, shape, and depth of the wound, these areas can better provide tissue for larger, more complex repairs. Although they may seem more complicated, they often produce a more reliable and better result.
One Stage Nasolabial Flap
Small defects less than 1.5 cm within the ala or sidewall can be repaired with a tongue of tissue elevated along the nasolabial fold and advanced or moved inward to cover the side of the nose and ala. Cartilage support from the septum or ear is frequently required. This is performed as an outpatient, as a single procedure. Usually, the defect is “patched”. It is not enlarged to conform to a subunit.
Two Stage Nasolabial Flap
Larger, deeper defects limited to the ala may be repaired with a Two
Stage Nasolabial Flap. Skin is elevated and transposed (shifted) on a vascular pedicle (a stalk). Usually, the skin within the entire ala subunit is replaced to improve the final result, even if this requires removing a small amount of uninjured skin. Cartilage is always required. It is performed in two stages, three to four weeks apart. Both procedures are performed as outpatient surgery, at the hospital, under sedation or general anesthesia.
Forehead skin has been acknowledged for centuries as the best donor site for the repair of the nose. Its color and texture are ideal. The final forehead scar, which follows the removal of skin from the forehead, is usually minimal.
A forehead flap is used when the nasal defects is deep, large (greater than 1.5 cm in size), or requires replacement of lining or cartilage support.
Smaller defects are repaired with a Two-Stage Forehead Flap. A strip of skin which extends from the eyebrow to the hairline is elevated and carried to the nose on a vascular pedicle (stalk) which carries its blood supply. Because a forehead flap is thicker than normal nasal skin, its distal end is thinned at the time of transfer. The pedicle (stalk) is divided 4 weeks later.
Larger, more complex defects or those which require extensive support shaping or lining, are best constructed with a Three Stage Full-Thickness Forehead Flap over six to eight weeks. This 3 stage technique was developed by Dr. Menick to improve the results of nasal reconstruction.
The first stage “operation” of a 2 or 3 stage forehead flap reconstruction requires an overnight stay at the hospital. Second (or third) procedures are performed as an outpatient. All the procedures usually require general anesthesia.
Complex repairs may be further improved by a later revision to improve the appearance, function, or visible scars. The results of facial and nasal reconstruction can be excellent. Many examples of the forehead flap and nasolabial repairs are available on this website. Please click here to see our Before and After Photos
Click here for Nasal Reconstruction post surgery care instructions