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-Facial Reconstruction

Before & After Photos: Facial Reconstruction


Case Studies: Facial Reconstruction

Case 45

Height: 5 ft. 11 in.
Gender: Male
Post-op Timeline: 11 month post-op

This patient arrived at my office with a hole in his nose on Friday afternoon. His dermatologist told him that he was going to have a Moh’s procedure and then have a short reconstructive situation to fill the defect.

This patient, however, needed extensive counseling about the need for a median forehead flap. He is seen here 11 months after this two stage procedure and as you can see his nose morphology very much fits his natural profile. The forehead skin island is borrowed from an island that lives from a blood vessel that comes out of the upper rim of the eye. The skin is tailored in order to fit the contour of his nose and the aesthetic subunits principle is respected in order to give him the best results. Even with maximum magnification on the large screen, the patient’s scar placement is in the corners of his nose and around his alar base as well as the tip subunit. This has been replaced as well with cartilage that is borrowed from his nasal septum and partially from his ear in order to accomplish a more natural look.

These Moh’s type cancer reconstructions can be performed in my practice in a single stage procedure and I welcome you or your friends or relatives should you have a basal, squamous cell or other malignancy of your nose that requires plastic surgical attention.

Case 371

Height: 5 ft. 6 in.
Gender: Female
Post-op Timeline: 3 months post-op

This patient came to me with a basal cell in her upper lip that extended to the base of her nose. She had watched this for some months and was told that it was simply a rash.

The patient had a biopsy that demonstrated a basal cell and because of her reconstructive needs she needed a cheek flap that went around the base of her nose, reposition her alar base and extend it onto her upper lip. This facial reconstruction flap has the goals of not distorting the lip or the nose base. Seen here intra-operatively, the patient’s margins are clear and now the reconstructive effort to fill in similar tissue from her facial tissue is required.

One of the options is of course to put a skin graft there but the local tissue rearrangement with fat facial flap is far more versatile and will give her a longevity of result as well as an outcome that can be seen here at 3 months post-op. The patient is obviously delighted and has much more confidence in her appearance now that she has had her malignancy removed with a clear margin as well as a flap reconstruction in a single surgical effort.

Should you or your relative have a cutaneous malignancy of your face, I would welcome you to my practice. Basal cell, squamous cell and melanomas of the face require expert intervention!