Dollar for Dollar
Every feature/part of the face is unique and very specific in its quality of tissue. A tissue in one part of the body might not be available elsewhere in the body. Therefore for excellent results, tissue should be taken from whatever amount is available from the same part. For example to build one half of the nose, tissue from the other half should be taken. We name this technique Dollar for Dollar.
For example, all the hair on different parts of the body are different. Such as scalp hair, armpit, pubic, eyebrow, lashes, inside nostril, inside ear, on face, on abdomen, or on limbs are different. They have different rate of growth, thickness, direction, timing of graying, timing for vanishing, density per square inch, sebaceous secretions, final achievable length, hormonal behavior, age wise behavior, sex and race.
In the above picture, the donor eye brow donated 50% of the recipient eye brow and 25% of supra orbital forehead to reconstruct the tissue of upper eyelid of the recipient side. 40% of donor ala was gifted to recipient ala. The remaining 20% of the defect of alae was halved so that 10% of the defect lies on each side far laterally away from the mirror view of the patient.
40% of the moustache of the donor side was shifted to the recipient side of the face. In doing so we did not alter the central philtrum component. It was elevated by giving 2 incisions, para philtrum column, full thickness and elevating the component anteriorly and forwardly and superiorly, padical based on columella.
Later on the reconstructive lip was divided into two equal halves and the central landmark, the philtrum component in its central seat.
Similar procedure was adopted for the lower lip and for the chin.
This is how we fulfill the conditions of dollar for dollar and dividing the defect 50/50.