Will Massage Help my Nose to Look Normal Faster After a Staged Reconstructive Forehead Flap Graft Post Dog Bite?

Question

Four months ago I suffered a dog bite where I lost the right side of my nose (and underlying cartilage). I had a staged forehead flap graft (with cartilage from my ear). I am pleased with the outcome thus far but am wondering if massage of the nose will help it to look better faster and what can I do so that the graft looks the same color as my existing skin? I have had steroid injections in the forehead as well as the periphery of the nose. Any insight would be greatly appreciated.

Aaron Stone, MD · Answer

Your injury was difficult to reconstruct given the loss of skin, fat, cartilage and most likely nasal lining as well as the margins of loss being outside the boundary of aesthetic units. If the edges of the reconstruction lie along the edges or borders of an aesthetic unit the result is much more natural looking. If the loss of tissue extends into an adjacent aesthetic unit the surgeon takes some risk in cutting out normal healthy tissue in order to reach the edge of that unit. It can be a tough decision to make even in the hands of the most experienced surgeon. Sadly this skill set will become increasingly harder to find the way health care is going in this country.

	The question is what do you do now to improve the result which is still certainly better than not having done anything and walking around with a large piece of missing nose. The color difference will diminish with time as this skin gets the same exposure to sun etc as the surrounding nasal skin. The puffiness and loss of definition at the very tip, alar groove and nostril rim will not go away with time or massage. You will need to have some thinning of the fat layer under the transferred patch of skin and a breaking up of the circular scar line. To avoid skin loss this will likely require a couple of small procedures instead of doing it all at once. Circular scars tend to cause the skin inside the circle to puff outward. Even if the edge was taken out all the way to the edge of the next aesthetic unit it is likely you would have needed some revision surgery. Thinning of forehead flap fat sometime after its transfer to the nose is quite commonly required.

	At this stage I don't think anyone would be willing to remove the reconstruction, extend the wound to the edge of the next unit and redo the whole reconstruction. It would be a lot of work with questionable benefit.

	My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Kenneth D. Steinsapir, MD · Answer

It is very, very common to need additional reconstructive surgery after such a complex trauma.  I would judge the result that you have as unacceptable but I do not fault your surgeon.  For a first step in reconstruction, there is often only so much that can be done.  Message will not expedite the improvement of this situation.  The graft that was placed needs more time to heal.  Ultimately you will benefit from further reconstructive surgery.  Making these better does require a great deal of experience.  Your original surgeon may be up for the challenge or not.  It is worth speaking to them about your result so far.  Encourage them to be honest.  Some surgeons will be reluctant to perform additional reconstruction, others will be open to this.  As you live in Maine, you might consider traveling to Boston or Providence for a second opinion either from an academic general plastic surgeon or facial plastic surgeon who regular does nasal reconstruction.  Remember, this is not cosmetic surgery, rather it is a reconstructive situation.

Will Massage Help my Nose to Look Normal Faster After a Staged Reconstructive Forehead Flap Graft Post Dog Bite?

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Will Massage Help my Nose to Look Normal Faster After a Staged Reconstructive Forehead Flap Graft Post Dog Bite?

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