BACKGROUND: Skin grafting is traditionally regarded as an inferior option for reconstruction of defects of the lower third of the nose. A full thickness skin graft is generally not considered the ideal replacement for the thick, sebaceous skin of the nasal tip, ala, lower sidewalls, and dorsum and many clinicians prefer instead to reconstruct these defects with local or axial composite flaps that incorporate skin, subcutaneous tissue, and fat.

METHODS: A retrospective analysis of 55 patients who underwent reconstruction of lower third nasal defects with full thickness skin grafts between 2002 and 2007 by the senior author. All of the patients in this review underwent skin cancer ablation by Mohs micrographic surgery.

RESULTS: Good aesthetic results, based on preoperative and postoperative photographic analysis of contour and pigmentation have been achieved in both the recipient and donor sites in 52/55 patients. Three patients experienced loss of the skin graft requiring alternative reconstructive techniques.

CONCLUSIONS: Under certain conditions skin grafting of defects of the caudal third of the nose offers a viable reconstructive option that yields good contour and color match. Preferred donor sites include forehead and preauricular skin. Careful analysis of defect size, location and depth, as well as consideration of donor site skin thickness, and pigmentation are vital to accurate replacement of the thick, pitted, sebaceous skin of the caudal nose. Secondary dermabrasion of the graft provides the critical step to obtaining final aesthetic contour and color. Case reports were selected to demonstrate technique and results.