PROCEDURES


PROCEDURES


Client Testimonial

My droopy eyes made me look sad and tired. Dr. Khosh performed my eyelid surgery as a simple office procedure. My upper eyelid surgery rejuvenated my eyes and boosted my self-confidence. I look and feel terrific. Thank you Dr. Khosh!

Marlene S. - New York, NY

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Nasal reconstruction is aimed at restoring form and function to this intricate and prominent feature of your face. Nose reconstruction may necessary in a variety of scenarios: nasal fractures, nasal defects from trauma or cancer removal, nasal collapse from underlying medical conditions or substance abuse, and nasal deformity from congenital abnormalities.

Repair of nasal fractures is the commonest form of nose repair. In most cases, the repair can be performed, within 10 days of the accident, under local anesthesia during an office visit. Occasionally, treatment of a broken nose is performed in delayed fashion as a surgical procedure in the operating room. The delayed treatment is similar to a rhinoplasty (nose job).

Skin cancer removal from the nose may result in defects that are small and superficial or massive and full thickness involving the internal nose. Repair of larger defects is particularly deserving of an expert surgeon who can restore the inner lining, the cartilage or bony framework, and the external skin. A variety of techniques such as skin grafts, local skin flaps, forehead flaps, nasolabial flaps, and cartilage grafts may be required in repair of cancer defects in the nose.

A collapsed nose, also known as a saddle nose deformity, is a devastating deformity that is fortunately rare. The saddle nose deformity is a consequence of loss of support from the septum (the wall inside the nose). Three categories of problems can lead to a collapsed nose: 1. Severe nasal fractures, 2. Underlying medical conditions (e.g. Wegener’s granulomatosis, relapsing polychondritis, and sarcoidosis), and 3. Intra nasal, recreational drug use. The surgical correction involves use of cartilage or bone grafts to support the nose.

Finally, congenital problems can cause abnormalities and distortions of the nose. Patients with cleft lip develop well-recognized deformities involving the tip of the nose. These deformities are best treated upon completion of the nasal growth. Vascular malformations or hemangiomas can cause nasal distortion or dysfunction and can require combination of laser and surgical treatment to restore the nose.

Dr. Khosh has extensive experience in nasal reconstruction from any cause. In the case studies listed below, you may see select examples of various nasal repairs.

  • 2010 Patients' Choice Award
  • 2008-2009 & 2010-2011 Best Doctor List.
  • Past President of New York Facial Plastic Surgery Society.
  • Assistant Clinical Professor at Columbia University.
  • Past Director of Facial Plastic Surgery at Columbia Univeristy.
  • Founding Member of new York Head & Neck Institute.
  • Affiliate Member of Vascular Birthmarks Institute of New York.
  • 2001 Columbia University Maxwell Abramson Teaching Award.

Case Study

This 76 year old lady requested consultation for nasal repair in Manhattan. She had removal of a Basal Cell Cancer from her nose which resulted in the loss of the majority of her nostril rim. A two stages naso-labial flap was used to restore her nostril.

  • Patient: 76 year old female candidate for nose repair after cancer removal
  • Problem: 0.5 x 0.75 inch defect of the nostril rim
  • Procedure: Naso-labial flap repair of the nose

FAQS

What kind of anesthesia is used during nose reconstruction?
The more minor treatments such as repair of a broken nose, or repair of a small skin defect on the nose can be performed under local anesthesia during an office procedure. More complex treatments require sedation or general anesthesia in an operating suite.
What is a forehead flap for repair of nose?
Large skin defects on the lower nose, including the tip or the dorsum, as best repaired with a forehead flap. A forehead flap is a two staged surgical procedure. During the first stage, a flap of forehead skin, that matches the size and configuration of the nose defect, is transferred to the nose to cover the defect. The blood supply for the flap is maintained from a bridge of tissue connected to the medial brow. In the second stage, the base of the flap at the brow is divided and the incisions are closed fully.
What is a nasolabial flap for nose repair?
Nasolabial flaps are ideal for repair of nasal skin defects in the nostril region. Nasolabial flaps can be designed as a single or two-staged procedure. Skin from the fold extending from the corner of the nose to the corner of mouth is transferred to the defect on the nose. In two staged procedures, further inset and refinement of flap is accomplished in second treatment two or three weeks later.
What is a bilobed flap for nose repair?
The bilobed flap is a surgical procedure that allows repair of a skin defect by transferring tissue from an adjacent site, and closing the newly formed defect in the donor area with a second smaller flap. Bilobed flaps are especially useful in reconstruction of skin defects on the nose that are less than 1 cm wide.
Why use ear cartilage or rib cartilage for nose reconstruction?
Occasionally, nasal deformities are secondary to loss of cartilage framework in the nose. Sometimes, residual cartilage inside the nasal septum can be used to replace such deficit. When adequate cartilage is not present in the septum, cartilage can be harvested from the external ear or the rib. When done properly, there is no visible deficit from such harvesting.
What is rhinophyma?
Rhinophyma is excess skin thickening in the lower part of the nose due to a chronic skin infection known as Rosacea. The result is progressive enlargement and deformity to the tip of the nose. Treatment involves control of the infection and surgical or laser removal of the excess skin in the tip of the nose.

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