Direct tissue expansion of the contracted nose.

INTRODUCTION Newman, in 1957, was the first to describe the use of inflatable balloons to allow for the expansion of cutaneous tissue for closure of skin defects. Since that time, tissue expansion has been used in many areas of the body, including the face. It provides for closure of defects that would not be amenable to primary closure or where significant donor site morbidity would be created from flap reconstruction. Tissue expansion offers several unique advantages as compared with other reconstructive modalities. It results in skin of similar color, thickness, and hair-bearing characteristics. In addition, sensation is maintained. Tissue expansion may be repeated several times in the same location to provide for additional coverage if this is required.1,2 Tissue expansion does have risks, including implant related problems of extrusion, exposure, and rupture and patient related issues of wound breakdown, infection, hematomas, and cutaneous necrosis. In addition, there is a significant period of prolonged visible deformity during the expansion phase, especially when used in the head and neck. Within the head and neck, tissue expanders have been used in nasal reconstruction, scalp expansion for hair replacement, eyelid expansion, and cheek and neck expansion for repair of defects of the neck and lower two thirds of the face. There have been several previously reported techniques for tissue expansion in nasal reconstruction. They