Clinical StudiesFull-Thickness Entire Nasal Alar Reconstruction Using a Forehead Flap in Asians No Cartilaginous Infrastructural Lining Is NecessaryFunayama, Emi MD, PhD; Yamamoto, Yuhei MD, PhD; Furukawa, Hiroshi MD, PhD; Murao, Naoki MD, PhD; Shichinohe, Ryuji MD, PhD; Yamao, Takeshi MD; Hayashi, Toshihiko MD, PhD; Oyama, Akihiko MD, PhDAuthor Information Department of Plastic and Reconstructive Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan. Address correspondence and reprint requests to Akihiko Oyama, MD, PhD, Department of Plastic and Reconstructive Surgery, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan; E-mail: [email protected] Received 22 September, 2016 Accepted 14 October, 2016 The authors report no conflicts of interest. Journal of Craniofacial Surgery: May 2017 - Volume 28 - Issue 3 - p 734-737 doi: 10.1097/SCS.0000000000003389 Buy Metrics Abstract Full-thickness defects of the entire nasal ala, including the rim, can be challenging to reconstruct. A forehead flap may provide a more imperceptible and natural-appearing reconstructed nasal ala. Previously, many authors have insisted adding cartilaginous infrastructural support for an entire, full-thickness defect to keep the postoperative alar structure symmetrical. They finally use a forehead flap after thinning of the distal covering portion subcutaneously, possibly for a Caucasian-type nasal ala. However, Asian skin has a thicker and more compact dermis than that of Caucasian skin, and the Asian ala is rounder and thicker. There may be another approach for an Asian-type nasal ala. The authors propose the possibility of nasal alar reconstruction for an entire, full-thickness defect in Asians using a forehead flap without structural support. Six patients with entire full-thickness nasal alar defects treated with full-thickness forehead flaps above the periosteum without structural support were reviewed. Five patients demonstrated esthetically good to excellent outcomes in color, texture, and symmetry. Their nasal linings were reconstructed using mucoperiosteal flaps or mucosal grafts. One patient treated with a nasal lining using a local flap showed a fair result esthetically. Asians forehead above the periosteum has adequate thickness and supportability to reconstruct the entire full-thickness nasal ala in Asians. No cartilage support is necessary. © 2017 by Mutaz B. Habal, MD.