Background: A young child with a badly deformed nose is a dilemma to a plastic surgeon. There is an impulse to rebuild the nose; however, confusion exists regarding the optimal technique.
Methods: The forehead flap achieves excellent aesthetic and functional results, has acceptable donor-site morbidity, and grows as the patient grows. The donor site heals well in children because of the nonsebaceous quality of their forehead skin; however, some scars may require revision. Only the forehead flap can eliminate a substantial nasal deformity and create a nearly normal or normal appearance that enables the child to grow and develop normally without the stigma and psychological insult a nasal deformity bestows.
Results: The methods above are further illustrated in a case example of a 9.6-year-old female pediatric patient. This young girl is one of a series of 25 pediatric nasal reconstruction cases to appear in a forthcoming comprehensive book on the subject. In this patient, a forehead flap was an appropriate option to eliminate her deformity. Reshaping the nose with small local flaps, cartilage grafts, and/or composite grafts would merely have softened her deformity and never eradicated it.
Conclusions: Use of a forehead flap and cartilage grafts does not automatically create a normal, aesthetic nose, especially for a child. Correct framework, form, and dimension are required, or the result will be merely a new but different deformity. Creation of a nose requires artistic and surgical ability, and can be learned by careful study of the technical aspects and artistry of aesthetic nasal reconstruction in children.