Reconstructive rhinoplasty.

Reconstructive rhinoplasty for larger nasal defects requires a three-dimensional perspective using many of the aesthetic and functional techniques commonly employed in rhinoplasty. There are numerous ways of addressing a deficiency of the internal lining and each technique is detailed. Structural grafting is imperative in order to resist the contracture and collapse of the reconstructive nose. These grafts are also used to enhance contour and definition. Resurfacing of large cutaneous defects is frequently achieved through the midline forehead flap. There are many subtle maneuvers which can significantly impact the final aesthetic outcome and these are discussed below. This article highlights the three-layered approach to subtotal and total reconstructive rhinoplasty.