Figure 2. The<unk>  defect after adjustment to the aesthetical subunitsFigure 3. The full-thickness<unk> <unk>  is sutured into the recipient site during stage one The two most used<unk> <unk>  techniques are the two stage and three stage<unk> <unk> . The<unk>  consists of multiple layers; skin, subcutaneous tissue, frontalis muscle with fascia and a thin areolar layer. Traditionally, the<unk> <unk>  is transferred in two stages, where the<unk>  is thinned during the first stage to improve the aesthetic result, possibly jeopardizing its vascularity and increasing chance for<unk>  necrosis. To overcome this problem, Menick described a three-stage<unk> <unk>  technique, where initially the<unk>  is transferred containing all tissue layers, making it an extremely safe technique. Only during the second stage, the<unk>  - which now acts as a delayed<unk>  - can safely be thinned aggressively according to aesthetic needs. During the final stage the pedicle is severed, the<unk>  is thinned further and pedicle and<unk>  are trimmed and inset. This three stage<unk>  is especially useful for reconstructing large defects, complex contour deformations, or lining defects, while the two stage<unk>  is used for smaller and superficial defects. Figure 4. The result after stage 1, without initial thinning of the<unk>  Figure 5. Situation before the second stage of reconstruction Figure 6. Elevation and thinning of the<unk>  during stage 2 Figure 7. The healed excess soft tissue and cartilage have been sculpted to improve contour Figure 8. The thinned<unk>  skin is returned to the contoured recipient Figure 9. The end result after a three-stage<unk> <unk>  Before surgery all important landmarks and reference points must be identified and marked. Important landmarks are the hairline, frown lines, location of the supratrochlear vessels, outline of the defect,<unk>  and lip subunits. Then templates are made<unk>  the intact side of the nose to make a precise symmetric reconstruction of the nose. The template resembling the defect is placed just under the hairline and the vascular pedicle is drawn downwards into the medial eyebrow. The pedicle is based on the supratrochlear vessels and can be 1.2 cm wide. This way the<unk>  design has been made. Two-stage<unk>  First stage The<unk>  is incised and elevated from distal to proximal. Distally, the frontalis muscle and subcutaneous tissue are excised, this is done for 1.5 to 2 cm. Then more downwards the disscection goes through the muscle and over the periosteum. When reaching the brow, all of the skin borders are incised and the<unk>  is carefully released. As soon as the<unk>  reaches the defect without tension further incision of the<unk>  is stopped and the<unk>  is inset into the area of the defect. This is done<unk>  a<unk> le layer of fine suture. Second stage The second stage is three to four weeks later, when the<unk>  is well healed at the recipient site. At this stage the pedicle is divided, the inferior<unk>  is reopened and the proximal pedicle replaces the medial brow by an inverted V. The nose side of the pedicle is elevated superiorly with 2 mm of subcutaneous fat. If needed the recipient site can be altered to reach a better aesthetic result. The scar is eventually sculpted between the<unk>  subregions to create a satisfying aesthetic result. Three stage<unk>  First stage The<unk>  is incised and elevated over the periosteum from distal to proximal. The<unk>  consists of skin, subcutaneous tissue, fat and frontalis muscle and is not thinned. When reaching the brow, all of the skin borders are incised and the<unk>  is carefully released. The full-thickness<unk>  is then sutured into the defect without tension. Second stage Three to four weeks later, when the full thickness<unk> <unk>  is well healed at the recipient site, the second stage begins. The skin of the<unk>  and 3–4 mm of subcutaneous fat is elevated. The underlying excess of soft tissue is then excised and the remaining healed tissue is sculpted in an ideal<unk>  subunit. The<unk>  is then resutured to the recipient site. Third stage This stage is completely identical to the second stage of the two stage<unk> <unk> . Revision For an optimal aesthetic result a difficult nose reconstruction is often followed by revision surgery. There are different types of revisions: minor revisions, major revisions and reoperations. Revisions are done not sooner than eight months after completion of the primary<unk> <unk>  technique.
Nasal reconstruction using a paramedian forehead flap
Alveolar cleft grafting
Clitoral hood reduction
Frenuloplasty of tongue
Facial feminization surgery
Frenuloplasty of prepuce of penis
Greyhound therapy
Scalp reconstruction