Kee Yang Chung
Educational Background
Yonsei University College of Medicine, Seoul, Korea (1980. 3 - 1984. 2), MD
Graduate School, Yonsei University, Seoul, Korea (1985. 3 – 1993. 2), BS & PhD
Work Experience
Assistant Professor of Dermatology, Yonsei University College of Medicine,1996. 3
Associate Professor of Dermatology, Yonsei University College of Medicine,2002. 3
Professor of Dermatology, Yonsei University College of Medicine, 2007. 3 ~ present
Chairperson, Department of Dermatology, Yonsei University College of Medicine (2015. 3
– 2019. 2)
Topic: Nasal Defect Reconstruction
Abstract:
Of all the cosmetic subunits on the face, nose displays the most 3 dimensional shape and, therefore,
challenges us with the most daunting defects to repair after a tumor removal. Moreover, since it's
symmetrically situated in the center of the face, even a small deviation from the preoperative morphology
is likely to draw attention and bring on stressful circumstances for the patients.
Nose is sub-divided into 9 aesthetic subunits. Although some variation in the dimension of the subunits
may exist among races and individuals, the general shape is constant and universal. The dorsal subunit
and both sidewall subunits comprise the largest surface area of the nose and are mostly lined by thin and
elastic skin with less sebaceous gland. Tip and both alar-nostril sill subunits encompass the lower part of
the nose and are covered with thick and sebaceous skin which makes them more difficult to manipulate.
Columella and both soft triangles are small aesthetic subunits but they are crucial in defining the shape
and symmetry of the nasal openings. Each of these subunits should be respected and restored as best as
possible when repairing a nasal defect to preserve the original architecture and symmetry.
Just as any other defects in other parts of the face, nasal defects can be reconstructed with simplest
secondary intention. However, although second intention healing can result in a fine and imperceptible
scar, symmetry can be sacrificed depending on the location of the defect. Primary closure is a very useful
tool for the smaller defects in the upper subunits and in the midline defects of the tip subunits. Skin
grafts have to be used with caution because the texture of the nasal skin can be so different from the
donor areas. In order to match the texture of the recipient skin, donor skin has to be harvested from the
areas with the most similarity in the density of the sebaceous appendages. Local flaps and interpolated
flaps are the workhorses for repairing the nasal defects since they can match the texture of the skin and
respect the aesthetic subunits. No matter what reconstruction method we use, we should aim to restore
the original 3 dimensional architecture and symmetry and hide the scar lines along the borders of the
subunits.
