Many reconstructive options can be performed depending on skin defect wideness: full-thickness skin grafts, composite grafts like perichondral cutaneous composite grafts or skin/cartilage composite grafts, local or regional flaps [13]. All these techniques, however, are not free from complications and require perioperative and postoperative cares. Moreover, these techniques are associated with multiple scars that, although they may follow discharge lines that make them less visible, are still long and located in the center of the face.

Large defects of the nasal tip require local flaps that can sometimes take more than an hour, causing discomfort for patients, especially the elderly, while regional flaps are usually performed under general anesthesia, so not all patients can undergo major surgery. In this regard, compared with dermal matrices, fat grafting allows the skin and subcutaneous defect to be restored while containing costs.

Another common problem is trap door deformity: Circular scar contracts during wound healing causing elevation of the flap that results in a pin-cushion appearance that often needs a second surgery [9].

Our free fat grafting is a good reconstruction option because it takes advantage of re-epithelialization and natural wound healing. The fat supports the tissue, generating skin that is entirely like the surrounding skin, with no color mismatch or tissue excessive depressions. This reconstructive technique has been employed by the authors in the management of scalp defects, yielding highly satisfactory results [14]. Surgery can be performed under local anesthesia also in elderly patients and those patients with comorbidities or anticoagulant therapies that do not need to be suspended. Our experience also showed that although the fat is uncovered, no infection was observed in any of the patients, even in those with diabetes and other comorbidities. Fat necrosis/lipolysis is also an infrequent event and usually involves the outermost, superficial portion. Finally, the proposed technique has some shortcomings including the long healing time, the common formation of hematoma at the donor site, the need for numerous dressings, and some cautions to achieve optimal esthetic results. Regarding this last point, we found no difficulties in properly instructing patients, even those who seemed less compliant, and likewise, limited to our experience, patients did not complain about the numerous dressings, or the costs associated with them. Regarding the first point, it must be considered that reconstruction with a forehead flap requires a second surgical time for flap autonomization and is therefore associated with a total healing time quite similar to that of fat grafting with a greater discomfort for the patient of having a bulky dressing that occupies the entire central part of the face for many days.

For these reasons, we believe that fat graft is a good reconstructive option in nose reconstruction after full-thickness excision of malignancies.

To our knowledge, this is the first case series in which autologous adipose tissue grafting was used to repair a full-thickness skin defect of the nasal tip.