Craniofacial & Facial Reconstruction · Nose
Subtotal or total nasal reconstruction rebuilds most or all of the nose after major tissue loss, addressing both appearance and breathing.
How is this different from rhinoplasty?
It replaces missing nasal tissue rather than mainly reshaping an existing nose.
Subtotal reconstruction rebuilds most of the nose; total reconstruction rebuilds the entire nose. The lining, support, and outer skin may all need repair.
Will I need several operations?
Often, yes.
Transferring tissue, shaping support, separating a flap from its original blood supply, and refining the airway may happen at different stages.
Can it help breathing?
Creating a stable airway is an important goal.
The extent of tissue loss, internal scarring, and healing affect how much breathing can improve. Additional treatment may be needed.
01 · Overview
Subtotal or total nasal reconstruction may be considered after cancer removal, trauma, infection, or another cause of extensive tissue loss. The plan depends on what remains, including nearby skin, internal lining, cartilage, and bone.
A rebuilt nose needs more than an outer covering. The surgeon assesses the moist inner lining, the framework that holds the nose open, and the skin that covers it. Grafts move tissue without its own blood supply; flaps move tissue with a blood supply. [1]
This is different from cosmetic rhinoplasty, which generally changes the shape of an existing nose. Major reconstruction focuses first on replacing missing structures and creating durable coverage and an airway, while also working toward a balanced appearance. [2]
The lining protects the inside of the nose and helps keep the airway open. Missing or scarred lining can tighten as it heals, so rebuilding the outside alone may not provide a stable result.
Your reconstructive surgeon coordinates with the cancer team. Clear margins, plans for radiation, and ongoing cancer checks can affect when and how reconstruction proceeds.
02 · Concerns & Goals
Losing part or all of the nose can affect breathing, comfort, appearance, and confidence. Your surgeon will help you understand what can be rebuilt and what treatment may involve.
A large defect may involve the tip, bridge, nostrils, and nearby facial skin. The amount and location of missing tissue guide the plan.
Loss of support or lining can narrow the nostrils or allow the airway to collapse. Airflow needs its own assessment.
Previous surgery, radiation, scars, and nicotine exposure can limit tissue choices and make healing less predictable.
Temporary changes in appearance, visible dressings, and repeat operations can affect work, social plans, and emotional well-being.
03 · Options
These approaches may be combined rather than chosen separately. A consultation determines which tissues and stages fit your defect, health, and priorities.
Forehead skin provides outer coverage for a large nasal defect.
Cartilage or bone helps rebuild the nasal framework.
Tissue restores the inside surface of the nose.
Tissue from another body area is moved with its blood vessels.
Flaps and grafts serve different purposes. Reconstructing a large nasal defect may require both, with the sequence tailored to tissue loss and blood supply. [1] [3].
Some transferred tissue needs time to establish a dependable blood supply before it can be separated or reshaped. Healing between stages also helps the surgeon assess coverage, support, and airway size.
No. The name describes how much of the nose needs rebuilding, not one required technique. Remaining tissue, prior treatment, and the lining defect influence whether microsurgery is needed.
04 · Results
The goal is a durable nose that fits the surrounding face.
A supported, open airway is a central goal, but results vary.
Reconstruction is often a course of care rather than one surgery.
Reconstructive surgery can repair tissue loss, but scars and differences in appearance may remain. Discuss realistic goals before choosing a plan. [1]
05 · Recovery
Returning to work does not mean fully healed. Follow your surgeon’s instructions; strenuous activity requires clearance.
Recovery depends on the tissues used, donor sites, and stage of treatment. Each operation may have different restrictions; your surgical team's instructions take priority.
Step 1 · Day of each operation
The team checks the reconstruction and any donor sites. Depending on the operation, you may go home with support or stay in the hospital for monitoring.
Step 2 · First days to weeks
Swelling, bruising, congestion, and soreness are common. Visits focus on wound care, tissue blood supply, and any dressings, splints, or stents.
Step 3 · Following weeks to months
A flap connection may remain visible until a later operation. The surgeon decides when tissue is ready for separation, shaping, or additional support.
Step 4 · Months after reconstruction
Swelling and scars gradually change. Follow-up checks assess breathing, tissue stability, and whether further refinement would help.
Ask your surgical team whether compresses are appropriate and exactly how to use them.
A forehead flap may leave a visible bridge of tissue between the forehead and nose for a period of healing. It supplies blood to the reconstruction. Your team will explain how to protect it and when separation may be safe.
Possibly. Some repairs use stents to help maintain nostril shape or airway size. Whether you need them, how to clean them, and how long to wear them depend on your reconstruction.
06 · Safety
Temporary swelling, bruising, nasal stuffiness, donor-site soreness, and altered sensation are common. A staged reconstruction may look unfinished between operations. Ask your team which changes are expected for your particular repair.
Bleeding can occur at the nose or donor site. A collection of blood may require drainage or another operation.
Infection, wound separation, or slow healing may require treatment and can delay later stages.
Poor blood supply can damage transferred tissue. Urgent treatment or additional reconstruction may be needed.
Scar tightening, tissue bulk, or weak support can cause persistent or new breathing difficulty.
Uneven shape, noticeable scars, altered sensation, graft warping, or donor-site pain may occur. Rib harvest carries additional risks, including rare injury around the lung.
Anesthesia reactions, blood clots, and heart or lung complications are possible. Risk depends on your health and the extent of surgery.
Discuss these risks and your individual health history with your surgeon. [1]
07 · Costs
Compare written estimates for the same planned scope, including the number of stages, donor-site surgery, hospital care, and likely follow-up. Insurance coverage depends on your benefits, medical necessity, and authorization requirements.
Surgeon
Surgeon services for reconstruction, graft harvest, and planned stages.
Ask your surgeonAsk which stages are included and how unplanned repairs or later refinements are billed.
Facility
Anesthesia, operating-room services, and any hospital stay.
Ask your surgeonCheck whether each operation has separate charges and whether all providers and facilities are in network.
Supplies
Dressings, prescribed medicines, stents, and postoperative visits.
Ask your surgeonAsk which supplies and visits are included and whether donor-site care adds charges.
TRC
Any separately billed care-coordination or administrative services.
Ask TRCAsk whether these services are offered, optional, or separately charged, and what they include.
Your written estimate should explain the services included, any separate charges, and payment terms.
08 · Questions
No technique can promise that. Photographs from before tissue loss may help guide planning, but tissue availability, scars, and airway needs set limits.
Not reliably. Smell depends on airflow and the health of smell-sensing tissue and nerves. Rebuilding the visible nose does not necessarily restore those functions.
Sometimes. Radiation can affect blood supply and healing, so your surgeon may recommend tissue from outside the treated area or a different treatment sequence.
A prosthesis may be a reasonable option. A reconstructive surgeon and prosthetic rehabilitation specialist can explain its appearance, attachment methods, maintenance, and suitability for your defect.
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