Mohs surgery may provide effective removal of skin cancer from the nose with minimal tissue loss; however, this procedure still leaves open wounds that need reconstruction. Restoring nasal lining, support, and coverage requires skilled surgical intervention that addresses both cosmetic and functional requirements simultaneously.
Dr. Kristina Zakhary takes great care during each consultation to understand both aesthetic and functional goals for his patients, which allows him to discuss your nose reconstruction options and create personalized treatment plans specifically tailored for you.
1. Local Flap Reconstruction
As part of this type of flap reconstruction, your surgeon moves tissue from one part of your body (known as the donor site) to cover another area that needs coverage – this may involve not just skin but muscle, bone and fascia as well.
Local flaps rely on their own blood supply, making them less prone to complications involving the donor site than free flaps attached to distant vascular pedicles. This decreases postoperative trismus risk. Nasolabial and rhomboid flaps are examples of this technique.
Your surgeon may advise sleeping with your head elevated after these procedures to prevent swelling that could obstruct blood supply to your flap and affect its blood supply. When this practice can no longer be beneficial, your care team will let you know.
2. Skin Grafts
Some surgeons prefer using full-thickness skin grafts due to their greater availability and lower cost; however, local flaps may yield superior results depending on patient selection and surgeon technique.
Skin grafts require a separate source of cartilage support; typically obtained via an incision behind the ear. Sometimes after revascularization occurs, skin grafts appear dark or bruised – this does not indicate failure; allow time for healing naturally to take effect.
One alternative solution for full-thickness defects is using a split-thickness graft with retained fat, as this approach has the advantage of being less likely to create pincushioning deformities and more closely approximating normal tissue texture.
3. Forehead Grafts
For larger wounds in the nose, forehead flap surgery may be the only effective means of repair. This involves freeing a piece of skin on the forehead and stretching it across to cover it all the way across to be stitched into place before stitching it in.
Reconstructive surgery aims to replace cancer-scarred areas with new skin that restores function and form, under either local (awake) or general anaesthesia (sleep).
Before applying the graft to the nose, defatting can help enhance inosculation and revascularisation, thus reducing bulkiness of the graft and allowing surgeons to match its size to those of their nose dimensions. Once it has revascularised properly, stitching it onto the nose is an easy step.
4. Direct Linear Closure
Full-thickness nasal defects require lining as part of their reconstruction, with specific types of lining depending on the location, depth and quality of the defect itself. Skin quality overlying the defect also plays an important role.
Minor nasal defects at relatively convex areas (like the nasal tip and ala) can be repaired using linear closure, an easy one-stage procedure which recruits adjacent color and thickness-matched skin to fill in any gaps created by smaller defects. Scars from linear closure procedures tend to blend in naturally relaxed tension lines making scarring less visible compared to other reconstructive methods.
Mohs surgery offers patients several reconstructive options for nasal reconstruction, with nasal reconstruction being one such possibility. Dr. Kristina Zakhary will take great care evaluating your nose and facial anatomy during your consultation in order to create a surgical plan tailored precisely to you.
5. Open Rhinoplasty
At this procedure, an incision is made through the columella (the narrow strip of tissue between nostrils), which will eventually fade and become nearly invisible with time.
My private consultations involve an in-depth analysis of both cosmetic and functional goals for any nose jobs procedure, making sure patients understand that what may seem like minor cosmetic changes may have more far-reaching ramifications on the structure and architecture of the nose, necessitating more detailed work than originally estimated.
Open rhinoplasty allows me to more closely access the underlying cartilage structures and bones for better structural support without diminishing tissue integrity, shortening procedure times and recovery periods.
