Facial Plastic and Reconstructive Surgery
Core rules
Rhinoplasty assessment covers nasal valve function, tip support, dorsal contour and septal pathology. Osteotomies narrow the bony vault; grafts support the tip and dorsum. In facial trauma, ATLS principles come first: secure the airway before facial fracture repair. Le Fort I, II and III fractures involve progressively higher midface levels; mandible fractures are common and often require fixation. Orbital floor blowout fractures may cause entrapment with restricted upward gaze and diplopia. Nasal bone fracture reduction is easiest within 7–10 days before callus forms. Scar revision with Z-plasty lengthens a contracted scar, while W-plasty breaks a straight line; timing is usually after scar maturation. Local flaps include bilobed, nasolabial and paramedian forehead flaps for nasal defects; skin grafts suit selected shallow defects.
Worked example
A patient has a full-thickness nasal dorsum defect after Mohs excision. A paramedian forehead flap provides matching skin and a reliable blood supply in stages. The pedicle is divided later, and the donor site is closed primarily.
Traps
Do not revise a scar too early; wait for maturation. Do not overlook orbital entrapment after blunt trauma. Do not reduce a nasal fracture after callus has formed. Over-resection of the nasal dorsum in rhinoplasty creates an inverted-V deformity.