Abstract
BACKGROUND: Total reconstruction of the alar nasal subunit, often following traumatic or oncological amputation, presents a significant reconstructive challenge. This study compares the nasolabial flap (NLF) and the paramedian forehead flap (PFF) for their aesthetic and functional outcomes in this specific context. METHODS: A prospective, monocentric study included 28 patients who underwent total alar subunit reconstruction between 2017 and 2024. Patients were allocated to 2 groups based on the reconstructive technique: folded PFF or NLF. Postoperative assessment included patient satisfaction surveys and the Nasal Aesthetic and Functional Evaluation Questionnaire score to evaluate functional and aesthetic outcomes. RESULTS: Reconstruction with the PFF provided superior aesthetic outcomes compared with the NLF, with a mean Nasal Aesthetic and Functional Evaluation Questionnaire aesthetic score of 30 out of 35 versus 21.6 out of 35 (P = 0.01). No significant difference was found in functional scores. The PFF, however, required a significantly higher number of operative stages (mean 3.6 versus 1.4, P < 0.001). This procedural complexity influenced patient choice, with those prioritizing a limited number of procedures opting more frequently for the NLF. The surgical decision was guided by pre- and postoperative photographic analysis in 71% of cases. CONCLUSIONS: For total alar subunit reconstruction, the PFF offers superior aesthetic results at the cost of greater procedural complexity compared with the NLF. This study underscores the necessity of an individualized, patient-centered approach, balancing aesthetic goals against the surgical burden through shared decision-making.