Midface Reconstruction — Cheek, Eyelid, and Nasal Reconstruction Principles

This episode reviews the core principles of midface reconstruction, focusing on the cheek, eyelid, and nose as distinct but interconnected aesthetic and functional units.Topics include the greater than 50% subunit rule, aesthetic unit reconstruction, relaxed skin tension lines, trapdoor deformity, and the reconstructive ladder. Cheek reconstruction is discussed through regional zones, primary closure, V-Y advancement flaps, cervicofacial flaps, periosteal anchoring, and free flap reconstruction for through-and-through defects.Eyelid reconstruction is reviewed using the anterior and posterior lamella framework, with emphasis on the principle that one lamella must be vascularized. Techniques include pentagonal wedge excision, Tenzel flap, Hughes flap, Cutler-Beard flap, and Mustardé flap, with focus on eyelid margin alignment, ectropion prevention, and corneal protection.Nasal reconstruction is discussed using the three-layer model of lining, support, and cover. Strategies include septal mucoperichondrial flaps, turn-down flaps, cartilage grafting, bilobed flaps, nasolabial flaps, and the paramedian forehead flap based on the supratrochlear artery. Additional pearls include negative vector anatomy, medial canthal healing by secondary intention, smoking risk, and the importance of hiding scars in natural facial shadows.Part of Dr. Lara’s Plastic Surgery Compendium — a high-yield audio reference for plastic surgery trainees and surgeons.DisclaimerThis podcast is intended for educational purposes only and is designed for medical students, residents, fellows, and practicing healthcare professionals. It is not intended to provide medical advice, diagnosis, or treatment for any individual patient. The content presented reflects general surgical principles and should not be used as a substitute for formal medical training, clinical judgment, or consultation with qualified healthcare professionals. Listening to this podcast does not establish a physician–patient relationship.SEO / Topic Keywordsmidface reconstruction, cheek reconstruction, eyelid reconstruction, nasal reconstruction, aesthetic subunit principle, greater than 50 percent rule, cervicofacial flap, V-Y advancement flap cheek, Tenzel flap, Hughes flap, Cutler-Beard flap, Mustardé flap, eyelid lamella reconstruction, ectropion prevention, paramedian forehead flap, supratrochlear artery, bilobed flap, nasolabial flap, nasal lining support cover, trapdoor deformity, medial canthus secondary intention