Sometimes a flap is not needed for small defects on the alae. Sometimes they can heal on their own very well without deformity, sometimes a graft is all that is needed, sometimes you can do a little advancement flap from nearby skin. It is not that common unless it is very large and the alar rim is complete ablated that you need a mesolabilal or other type of flap. Scars are dependent on many things, the technique of the surgeon, the wound healing of the patients, and time. One thing I offer patients is laser resurfacing or dermabrasion post surgery to help the healing of the scars for a better cosmetic result. Best, Dr. Emer.
Well, depending on how small your site is, you may not even need a flap, so there would be less to repair. Scars can often be hidden very well in the nasal ala area if they are small enough. In this case, you should have minimal to no markings at 4 weeks post. If you do have a flap the recovery is a bit longer, but still should look good at that point in time. It's important to follow post-care tips from your surgeon for best results.
"This answer has been solicited without seeing this patient and
cannot be held as true medical advice, but only opinion. Seek in-person
treatment with a trained medical professional for appropriate care."
I agree with Dr. Kaufman that Mohs is your best option for removal of a nasal skin cancer (smallest defect, lowest possible recurrence rate). The reconstructive approach that you require will depend upon the size and the thickness of the wound left after removal of the skin cancer. Typically, by four weeks you should be well on your way to healing but this will depend upon how extensive the repair becomes. I hope this information is helpful for you.
Stephen Weber MD, FACS
Denver Facial Plastic Surgeon
There are a lot of variables in this situation. In my opinion I would treat the skin cancer with Mohs micrographic surgery (full disclosure... I am a fellowship-trained Mohs surgeon). Mohs surgery will provide the highest cure rate for your skin cancer. For a basal cell carcinoma not previously treated the reported cure rate is around 98.5-99%. Also Mohs surgery will create the smallest defect for repair because it starts with a smaller surgical margin and traces out the roots of the skin cancer. A smaller defect might mean a smaller or simpler flap or repair. I would also recommend a fellowship-trained Mohs surgeon with a lot of experience. Fellowship-trained Mohs surgeons have completed a 1-2 year fellowship in Mohs surgery, including Mohs surgery, reconstruction, and pathology. You can contact the American College of Mohs Surgery to get a list of doctors who have completed fellowships in Mohs surgery and are fellows of the College. There are of course other options for treatment that you could discuss with your doctor, especially with your concerns and start of your new job. For a nodular basal cell carcinoma other options would include radiation and topical medications (e.g. imiquimod). Talk to your dermatologist and good luck.