Maintaining Nasal and Facial Reconstruction Shape, Function, and Range of Motion

Conclusions

• Preserving subtle 3D facial landmarks such as grooves, apertures, and projection is essential because these details strongly affect both appearance and function.
• For nasal reconstruction, maintaining columellar length and lower tip redundancy is critical to avoid blunting the tip and distorting nasal proportions.
• The alar groove and apical triangle are key cosmetic and functional units that should be deliberately preserved or recreated during reconstruction.
• Through-and-through tacking sutures can help recreate the alar groove, support the nostril shape, and reduce unwanted internal or external bulk.
• Large defects often have more tissue laxity than expected, so simpler local closure strategies may be possible instead of automatically defaulting to free flaps.
• Three-point advancement closures can successfully reconstruct larger defects in mobile regions like the neck, shoulder, jawline, and hip while preserving range of motion.
• Transposition and rhomboid-type flaps are effective workhorse options when the goal is durable closure with good contour and minimal functional compromise.
• When using transposition flaps, the secondary defect should be closed first to avoid misalignment and preserve flap geometry.
• Postoperative swelling and early healing can look imperfect, but the final outcome may still preserve normal facial shape and patient satisfaction.
• Preventing contour distortion and maintaining nasal airflow are as important as closing the wound, especially in alar and sidewall reconstructions.