After a careful preoperative examination of the patient and clinical photographs, the defect is analyzed in terms of facial and nasal units and subunits to determine what is missing both anatomically and aesthetically. A detailed operative plan is outlined to determine the materials, methods, and required stages. The surgery should be performed in the operators "minds eye" and a written plan developed.
Choose techniques likely to reliably recreate normal form and function.
Consider a preliminary operation to return malpositioned structures to their normal positions or open airway.