PMC9840769_01
The patient with a 15 mm diameter stent in the nasal canal
wjps-11-103-g001.jpg
PMC9840769_01_wjps-11-103-g001.jpg
F1
The canal was epithelialized and for prevention of restenosis a stent was placed in the canal (Figure 1).
PMC9840769_02
Patient after tissue expansion under forehead skin and reaching a total capacity of 800 cc
wjps-11-103-g002.jpg
PMC9840769_02_wjps-11-103-g002.jpg
F2
It was inflated every week with 20-30 cc of normal saline until reaching the total capacity of 800 ccs (Figure 2).
Drawing two flaps with a 5 cm pedicle
wjps-11-103-g003.jpg
PMC9840769_02_wjps-11-103-g003.jpg
F3
The flap which was used to cover the future columella and the tip of a longitudinal skin strip was de-epithelialized on both sides (Figure 3).
Finding feeding arteries on pedicles by transillumination
wjps-11-103-g004.jpg
PMC9840769_02_wjps-11-103-g004.jpg
F4
Before incision of skin flaps, by transillumination through the expanded forehead skin we became confident that each pedicle had a feeding artery (Figure 4).
Divided a block of cartilage into some pieces as columella and septum
wjps-11-103-g005.jpg
PMC9840769_02_wjps-11-103-g005.jpg
F5
On the side table, the block of the rib was sliced into 4 mm diameter and 5.5cm length stripes (Figure 5). Then a framework was made and also reshaped as needed (Figure 5and Figure 6). 
Framework of bone and cartilage as dorsum and septum
wjps-11-103-g006.jpg
PMC9840769_02_wjps-11-103-g006.jpg
F6
Then a framework was made and also reshaped as needed (Figure 5and Figure 6). 
Frontal flaps used as mucous and outer cutaneous layers
wjps-11-103-g007.jpg
PMC9840769_02_wjps-11-103-g007.jpg
F7
The donor area of the frontal flap was closed completely by primary approximation (Figure 7).