33959 Novel nasal alar reconstruction with hyaluronic acid after Mohs micrographic surgery and repair

Mohs micrographic surgery (MMS) has become a treatment of choice for certain nonmelanoma skin cancer, especially when lesions are located on aesthetically sensitive areas of the body such as the face. Due to the unique anatomy of the nose, reconstruction of nasal defects following MMS can present a challenge. Surgery to certain nasal structures, such as the ala, columella, or tip, can result in external nasal valve collapse. Reduction in the radius of the nasal valve areas by even a small amount can cause significant effect on nasal airflow and nasal resistance. Several methods may be employed for prevention or correction of nasal defects following MMS. For example, use of cartilage grafting has shown good results in maintaining nasal ala structure and reducing the risk of alar collapse. Furthermore, various suture techniques have been described that may be used intraoperatively to try to prevent alar collapse, including a 3-point suture and a suspension suture technique. In terms of postoperative correction, conservative measures are often used first. For instance, treatment of increased flap bulk causing compression may be done with steroid injection. If this should fail, flap debulking may become necessary to correct the issue. In cases of substantial external valve collapse, batten grafting has been used to repair the defect and improve inspiratory airflow. Here we present cosmetic filler as a novel method for treatment of nasal alar collapse in patients who may not wish to undergo surgical correction.