This is a great question. Various subspecialties can and do perform paramedian forehead flap reconstruction for nasal defects including Dermatologic/Mohs surgeons, Facial Plastic Surgeons, General Plastic Surgeons and even some Ear, Nose and Throat physicians. I think the answer for which doctor is the best really comes down to which physician has the most experience and performs these procedures regularly. There are some very good Dermatologic/Mohs surgeons that do excellent work while there are others that refer all their complex reconstruction including paramedian forehead flap patients to either a Facial Plastic surgeon or General Plastic surgeon. For example, in my practice I have a high volume of paramedian forehead flaps that I perform from local Dermatologic/Mohs surgeons that refer to me. Your best option is to call around and find a physician who performs a lot of these procedures. I would then schedule a consultation and ask to see their before and after photos. This will give you a good idea of what results to expect. I hope this helps.