I had MOHS laser to remove extensive basal cell carcinoma on my nose, and then a "flap" surgery to cover the damage? (photo)

Had MOHS laser on nose; flap surgery to repair; have big scars and large lump where flap attached; nose is pulled to one side; left nostril much smaller and I can't think of any procedure that could correct it! Surgery was December 8, 2014--3 months ago. Look like a freak. Wouldn't a skin graft have been better? Is there an alternative to MOHS and the flap repair?

Doctor Answers 2

Forehead flap thoughts...

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As noted, the paramedian forehead flap is a workhouse flap to repair large and/or complicated nasal defects especially after Mohs surgery.  I find that the forehead flap is one of the most cosmetic and useful flaps for repairing large Mohs defects.  Forehead flaps can be performed in as few as two stages while many perform this is in three stages.  I commonly utilize the CO2 ablative laser to smooth out any areas of thickness or contour irregularities.  This is a very safe and low risk procedure that may be of benefit.

Columbus Dermatologic Surgeon

Forehead flap repair of Mohs defect

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First, it's impossible to say whether a skin graft would have been superior to a paramedian forehead flap without seeing photos of the initial defect. This is a very powerful flap for certain nasal defects (large, deep or full thickness). The recovery, however, can be exhausting and take up to one year. Nasal reconstruction results can most often be refined. The forehead flap can be thinned and scars blended with laser. You do appear to also have some bulk on the left side of your nasal bridge in an area where I don't usually see it. To my eye, that is the most distracting aspect of the repair. I would try to be patient and followup with your surgeon. Refinement can typically begin around three months following surgery. Now is a good time to discuss what can be done to improve upon your initial results. If your surgeon doesn't feel that they can improve upon your repair, I would recommend seeking a second opinion. I hope this information is helpful for you.

Stephen Weber MD, FACS
Denver Facial Plastic Surgeon

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