The Use of Reduction Rhinoplasty to Accommodate a Local Flap for Large Nasal Tip Defect Reconstruction

Gudjonsdottir LR, Gunnarsson GL.

PubMed 40502425 Publisher (DOI)Free full text (PMC)

What this paper says

In seven patients aged 65 to 95 with skin cancers removed from the whole nasal tip, shrinking and lifting the tip made the defect small enough to close with a local flap in a single operation, without complications.

Overview

When a skin cancer excision removes the entire tip aesthetic unit, the defect can be too large for a local flap, forcing a forehead flap with multiple stages. The Icelandic authors reduced the alar cartilages and slightly lifted the tip, narrowing the soft-tissue gap so a local nasal flap could cover it in one stage. Seven cases across different nose sizes and shapes are presented.

Sections of note

7 patients, ages 65-95, each with a lesion involving the whole tip aesthetic unit.
Alar cartilage reduction plus slight tip lift narrowed the defect.
Local flaps gave wide exposure of the underlying support.
Single-stage reconstruction; uneventful recovery; no complications; satisfactory results overall.

What it means for a patient

For older patients with a large tip skin cancer, making the nose slightly smaller can avoid a multi-stage forehead flap.
The trade-off is a somewhat smaller, lifted tip, which the authors report as acceptable.
Seven cases with no outcome scores is a small series.

Why this paper matters

It applies cosmetic reduction principles to cancer reconstruction to simplify surgery in the elderly. Limits: seven patients, no measured outcomes, no comparison.

Terms

Aesthetic unit: a region of the nose (such as the tip) that heals best when reconstructed as a whole.
Local flap: nearby skin moved into a defect while staying attached to its blood supply.
Forehead flap: the standard multi-stage reconstruction for large nasal defects, using forehead skin.
Alar cartilage: the tip cartilages.
Reduction rhinoplasty: surgery that makes the nose smaller.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

Abstract

A nasal tip defect can pose a reconstructive challenge, especially if the defect size overrides the availability of a local flap for coverage. We decreased the size of the nasal tip and lifted it to accommodate a local flap reconstruction of a smaller nose. We present a case series of 7 patients 65-95 years of age who underwent removal of a nasal tip lesion involving the whole aesthetic unit of the nasal tip, to demonstrate the technique on noses of different sizes and shapes, with nasal tip reduction and local flap coverage. The operation and recovery were uneventful, and reconstructive goals were achieved without any complications in a single stage with overall satisfactory results. The local flaps of the nose allow for wide exposure of the underlying nasal support. Reduction of the alar cartilage and slight lift of the nasal tip narrows the soft-tissue defect sufficiently and allows for a simple local flap reconstruction.

Abstract as indexed by PubMed; the article is open access (PubMed Central).