Typically in the first stage a strip of skin from the forehead is brought down to the nose but is kept connected to the forehead through a strip of connecting tissue. Often parts of the tip of the nose must be reconstructed by using cartilage taken from behind the ear. This does not significantly change the shape of the ear. This strip of forehead skin must then stay attached for 3 weeks (click for image). This is the length of time necessary to establish a proper blood supply to the piece of skin being transferred. Understandably, this can be a difficult time of being out in public for many patients.
The second stage of the operation is where we put everything back together. The connection between the forehead and the nose is divided. The skin is contoured to look like nasal skin and both the nose and forehead are stitched fully back together.
Less commonly a third stage is needed. This is most often the case when a significant amount of the nose has been lost to cancer or if the reconstructed area needs further refinement to achieve optimal nasal contouring. If you need a 3rd stage, or more, this will be discussed in detail in your initial consultation. The most stages one patient has needed for an extremely complex and massive loss of the nose was 5-6 stages.