Nose Reconstruction

Nose reconstruction is one of the most demanding sinus and nose procedures, best performed by a surgeon with subspecialty training in the intricate, three-dimensional anatomy of the nose. The goal of nasal reconstruction is restoring both form and function to one of the most prominent and structurally complex features of the face. Nose reconstruction may be necessary across a variety of scenarios — nasal fractures, nasal defects from trauma or skin cancer removal, nasal collapse from underlying medical conditions or substance use, and nasal deformity from congenital abnormalities. Each of these situations requires a different reconstructive approach tailored to the specific damage and the patient’s individual anatomy.

Rebuilding the nose is among the most complex work in facial plastic surgery, because the nose is a three-layered structure — an inner lining, a cartilage and bone framework, and an outer skin envelope — and a successful reconstruction must restore all three while preserving both appearance and breathing function. Dr. Maurice Khosh’s three decades of nasal reconstruction span fractures, cancer defects, saddle nose deformity, and congenital abnormalities. As the former Director of Facial Plastic Surgery Clinics at Columbia University Medical Center and a dual board-certified surgeon — including certification by the American Board of Otolaryngology–Head and Neck Surgery — Dr. Khosh is a Fellow of the American College of Surgeons (FACS). He has been recognized as a perennial Castle Connolly Top Doctor and a Best Doctors in America honoree.

The Three Layers of Nasal Reconstruction

A successful nose reconstruction must address each of the nose’s three distinct anatomical layers:

• Inner Lining: The mucosal lining inside the nose, essential for normal nasal function and for supporting the structural framework
• Structural Framework: The cartilage and bone that give the nose its shape and provide the support necessary for breathing
• Outer Skin Envelope: The external skin covering, which varies in thickness and character across different regions of the nose

When a defect involves only the skin, reconstruction can be relatively straightforward. When a defect is full-thickness — involving all three layers — reconstruction becomes substantially more complex, requiring restoration of each layer in proper relationship to the others.

Nasal Fracture Repair

Repair of nasal fractures is the most common form of nose repair:

• Early Repair Window: In most cases, a fractured nose can be repaired within approximately 10 days of the injury, often under local anesthesia during an office visit
• Closed Reduction: For many fractures, the bones can be repositioned without external incisions through a closed reduction technique
• Delayed Surgical Treatment: When fractures are not addressed within the early window, or when the fracture is complex, repair may be performed later as a surgical procedure in the operating room
• Delayed Repair Resembles Rhinoplasty: Delayed nasal fracture treatment is similar in approach to a rhinoplasty (nose job), addressing both the healed deformity and any associated breathing problems

Reconstruction After Skin Cancer Removal

Skin cancer removal from the nose — most often following Mohs surgery — can leave defects ranging from small and superficial to massive and full-thickness:

• Small, Superficial Defects: Can often be repaired with direct closure or simple skin grafts
• Larger, Full-Thickness Defects: Require comprehensive reconstruction of the inner lining, the cartilage or bony framework, and the external skin — this is the work that most clearly benefits from an expert reconstructive surgeon
• Multi-Stage Reconstruction: Larger cancer defects often require multiple staged procedures to achieve the best result
• Cancer Surveillance Coordination: For patients with skin cancer, ongoing monitoring for recurrence is coordinated alongside the reconstruction

The reconstruction of cancer defects on the nose draws on a wide range of techniques depending on the size, depth, and location of the defect.

Saddle Nose and Collapsed Nose Reconstruction

A collapsed nose — also known as saddle nose deformity — is a devastating but fortunately rare deformity resulting from loss of structural support from the septum (the central wall inside the nose). Three categories of problems can lead to a collapsed nose:

• Severe Nasal Fractures: Trauma that damages or destroys the septal support
• Underlying Medical Conditions: Autoimmune and inflammatory conditions including Granulomatosis with Polyangiitis (formerly known as Wegener’s granulomatosis), relapsing polychondritis, and sarcoidosis
• Intranasal Recreational Drug Use: Chronic use that produces septal perforation and eventual collapse

Surgical correction of a collapsed nose involves the use of cartilage or bone grafts to rebuild the lost structural support. For patients whose collapse results from an ongoing medical condition or substance use, the underlying cause must be addressed and controlled before reconstruction.

“Nose reconstruction is one of the most rewarding areas of facial plastic surgery precisely because it is so demanding. Whether the cause is a fracture, a cancer defect, or a structural collapse, the work requires restoring multiple layers of tissue in correct relationship to each other — and the nose is so central to the face that even small improvements have a large impact on how the patient looks and feels. The most important factor is matching the reconstructive technique to the specific defect, because no two reconstructions are alike.” — Dr. Maurice Khosh

Congenital Nasal Deformity Reconstruction

Congenital conditions present from birth can cause abnormalities and distortions of the nose:

• Cleft Lip Nasal Deformity: Patients with cleft lip develop well-recognized deformities involving the nasal tip; these are typically best treated upon completion of nasal growth
• Vascular Malformations and Hemangiomas: These can cause nasal distortion or functional impairment and may require a combination of laser and surgical treatment to restore normal nasal shape and function
• Other Congenital Abnormalities: A range of less common congenital nasal variations, each evaluated and treated individually
• Timing Considerations: For many congenital nasal conditions, the timing of reconstruction relative to facial growth is an important part of the surgical plan

Reconstructive Techniques for the Nose

Nasal reconstruction draws on a comprehensive range of techniques, selected based on the specific defect:

• Skin Grafts: Thin skin grafts to cover superficial defects with skin from a matching donor site
• Local Skin Flaps: Tissue rotated or advanced from adjacent areas of the nose or face
• Forehead Flaps: For larger nasal defects, the paramedian forehead flap provides excellent skin match and is a workhorse of major nasal reconstruction
• Nasolabial Flaps: Tissue from the cheek/nasolabial region used for specific nasal defects, particularly of the nostril and ala
• Cartilage Grafts: Septal, ear, or rib cartilage used to rebuild the structural framework
• Bone Grafts: For defects involving loss of bony support
• Inner Lining Reconstruction: Specialized techniques to restore the mucosal lining when full-thickness defects are present

Why Choose Dr. Khosh for Nose Reconstruction

• Three Decades of Nasal Reconstruction: Refined experience across fractures, cancer defects, saddle nose, and congenital deformities
• Former Director of Columbia University Facial Plastic Surgery Clinics: Academic leadership credential reflecting deep reconstructive expertise
• Full Range of Reconstructive Techniques: Skin grafts, local flaps, forehead flaps, nasolabial flaps, cartilage and bone grafts, and inner lining reconstruction all available
• Three-Layer Reconstruction Capability: Restoration of inner lining, structural framework, and outer skin in proper relationship
• Multidisciplinary Coordination: Established relationships with Mohs surgeons, rheumatology, and other specialties for cases requiring coordinated care
• Functional and Aesthetic Integration: Every reconstruction addresses both appearance and breathing function
• Dual Board Certification: Combined facial plastic and head and neck surgery expertise
• Park Avenue Convenience: Private Upper East Side practice serving patients from across Manhattan and the tri-state area

Schedule Your Nose Reconstruction Consultation in NYC

Whether your need for nose reconstruction results from a fracture, skin cancer removal, structural collapse, or a congenital condition, the first step is a thorough evaluation of the specific defect and a careful reconstructive plan tailored to your anatomy. Dr. Khosh has extensive experience in nasal reconstruction from any cause. Contact us today to schedule a consultation at his Park Avenue office in New York City, or call (212) 339-9988.