Achieving natural shading of the nostril in the reconstruction of a half nose

The secondary deformities in a patient who had a half nose that had been reconstructed inchildhood using a median forehead flap and the corrective procedures subsequently employed are described. The secondary deformities included elevation of the right alar rim and a completely visible nasal floor. These deformities were corrected with a scalping forehead flap and by changing the orientation of the reconstructed right nostril and nasal cavity. Nasal airway reconstruction may not always be needed, particularly in a congenital half nose such as described here. Instead, the aesthetic importance of the orientation of the reconstructed nasal cavity in order to obtain a normal shaded appearance in the nostril is emphasised.