The nose is located in the center of the face, in a prominent and independent position, and it plays a pivotal role in the overall facial aesthetic shape and the three-dimensional structure of the face. The complex three-dimensional structure of the nasal surface, the variation in the thickness of the surface-covered skin, the continuity of the nasal support structure from cartilage to bone, and the epithelial covering of its internal lining make nasal reconstruction occupy a special place in facial plastic surgery. Plastic reconstructive surgery of the nose dates back to 600 B.C. and has been documented as early as the ancient Indian period, where the removal of the nose was used as a common means of punishing people, thus leading to the rise of this procedure. Today, the etiology of nasal defects has changed, with malignant tumors of the skin, accidental car accident injuries, violent injuries, and animal bites now becoming more common factors leading to nasal defects. In the 15th and 16th centuries, BrancedeBranca created the “Italian method” of nasal reconstruction by applying an upper arm flap with a tip, and at the beginning of the last century, plastic surgery developed rapidly, and up to now, a number of methods of total nasal reconstruction have been formed. 1, the characteristics of nasal reconstruction Nose is located in the center of the face, by the root of the nose, nasal dorsum, nasal tip, nasal wings, nostrils, nasal columns, etc., composed of complex three-dimensional cone, and each part has its own specific length, width, height, curvature, and multiple curves, and other aesthetic factors, Burgett put forward in 1985, the surface of the nose by shallow ridges and valleys delineated by the ridge and valley of the nose, which will be divided into a convex and concave surfaces. The tip of the nose can be subdivided into the hemisphenoidal tip, the dorsum, the paired lateral walls of the nose, the flanks, and the soft triangles, and the shape of these depends on the contours of the hard and soft tissues underneath them. The defect should be varied in size and shape to fit the subunit of the nose, and when the size of the defect exceeds 50% of such subunit, the defect should be enlarged to the full extent of the subunit. If the defect is modified, the reconstructed nose will have a normal shape. Similarly, if the incision is designed to be made at the junction of two adjacent subunits, the postoperative scar will be well concealed. The methods of nasal reconstruction have undergone thousands of years of evolution, and it can be said that the history of nasal reconstruction is a microcosm of the entire history of the development of plastic surgery. Up to now, the methods of nasal reconstruction can be broadly categorized into two types: flap method and skin tube method. 1.1 Frontal flap: forehead flap nose reconstruction has a long history, as early as in the 15th century BC, India has been using the forehead flap nose reconstruction, known as the “ancient Indian method”. 1861, the British surgeon Carpue reported two cases of forehead flap nose reconstruction, the success of the operation. 1946, Kazanjian in the United States to popularize the use of flap nose reconstruction. In 1946, Kazanjian popularized the classic frontal median flap nasal reconstruction in the United States by taking a frontal median flap (including the superior talipes arteries on both sides as vascular tips) and rotating it 180 degrees downward for nasal reconstruction. Today the frontal flap is still a relatively mature surgical procedure and is the main method for total nasal reconstruction. The indications are: total nasal defect or anterior half of the nasal defect can not be repaired with auricular composite tissue flap or neighboring flaps at one time; the distance from the skin between the eyebrows to the hairline is more than 6 cm, there is no local skin scar, boils; and there is no damage to the suprachiasmatic arteries on both sides. The application of frontal flap for nasal reconstruction has the following advantages: the frontal flap has blood supply from the blood vessels of the superior talipotentiary artery, supraorbital artery, frontal artery and dorsal nasal artery, and the survival rate of the flap is high; the reconstructed nasal tissues are firm and do not need to be supported by bone grafts, and the skin elasticity, thickness, and color are all similar to that of the nasal area, which is beautiful; the tip of the flap is close to the root of the nose, which makes it convenient to be transferred. The disadvantages are as follows: postoperative scarring in the middle of the forehead, which affects the appearance; the operation needs to be completed in phase II, and the duration of the disease is long; the amount of tissue in the flap area is insufficient when the defect area is large. 1.2 Frontal expansion flap: in order to overcome the shortcomings of simple frontal flap nose reconstruction, Wang Liangneng proposed the application of frontal expansion flap nose reconstruction, the donor flap area can be directly pulled together and sutured, after the operation, the forehead only leaves an inconspicuous line scar, the forehead basically maintains the normal anatomical shape. The operation is divided into three stages: first, the expander is placed under the forehead capitellar tendon membrane and frontalis muscle, and then the expander is taken out when there is enough skin to be expanded, and then the expanded flap in the upper frontal area with the blood vessels of one side of the bursa as the tip is selected, and the flap is rotated 180 degrees to reconstruct the whole nose. The color and texture of the expanded flap was similar to that of the adjacent tissues, and the toughness was good. The expanded forehead flap was thinner and more elastic than the unexpanded forehead flap. It has good resistance to oxidation. At present, 10 cases of total nasal reconstruction have been completed by this method in our department, all of which have achieved good surgical results. 2. Problems and prospects Reviewing the history of nasal reconstruction, it can be seen that although there are many surgical methods for nasal reconstruction, various surgical styles have corresponding indications, advantages and disadvantages. In general, the choice of applying a forehead flap or a forehead expansion flap for nasal reconstruction is favored without damage to the forehead skin. With the continuous development of forehead flap rhinoplasty, the paracentral flap has gradually replaced the median flap because of its small influence on the blood flow of the tip, easy rotation and other advantages. The selection of the flap has also developed from the traditional thick flap carrying a large amount of frontal muscle to the thin flap carrying a small amount of frontal muscle or even the ultra-thin flap, but the theoretical basis of its blood flow is still to be further investigated on the fine anatomy of the forehead blood vessels as well as the construction of microvessels. With the current cosmetic plastic surgery technology, the development of three-dimensional image analysis technology, microanatomy technology, genetic engineering technology, biomechanical testing and analysis technology, as well as biocompatible surrogate scaffolds and engineered products for the whole nose in-depth research. It is believed that in the near future, noses with shape, color, texture and function perfectly matching the defect can be manufactured from the laboratory and supplied for clinical transplantation, which will be a great leap in the history of plastic surgery and even medicine in general!