Leave the Fat, Skip the Bolster: Thinking Outside the Box in Lower Third Nasal Reconstruction

In the 2004 study by Thomas J. Hubbard, M.D., 33 skin and fat composite grafts were applied to 29 patients for lower third nasal reconstruction, with graft sizes ranging from 4 mm to 17 mm × 16 mm. The study found that these grafts, which retained 1 to 5 mm of fat and were taken from the nasolabial area, were effective in reconstructing nasal defects without the need for bolsters. The results showed a high survival rate with 29 complete grafts and only 4 experiencing central necrosis, primarily in smokers. One case had excess fat leading to protuberance. The study also reported a 31% rate of hypopigmentation in the grafts. Overall, the study concluded that nasolabial skin-fat composite grafts provide a valuable reconstruction option with good to excellent contour, minimal scarring, and without distorting nasal anatomy, although smoking history might be a risk factor for graft survival.