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

Thank you for your question. Without reviewing photos of your nose defect I cannot comment on if a skin graft would have been suitable to use. What I can comment on is that I use a forehead flap for all major nose reconstructions. It is reliable and can give outstanding results. However the art of nose reconstruction is in tailoring the flap (forehead flap or other flap) on second and third stages to make it blend with the nose so scars are not visible. I have reviewed your photos, you have left alar retraction, residual scarring on the forehead from the forehead flap donor site, redness around the incision sites and a degree of pincushioning of the flap on the nose. Some of these (pincushioning, redness) may settle over the next 3 months. The alar retraction will unfortunately in my opinion not resolve. If these issues persist they can be addressed by revision surgery. If your problems do not resolve and your current surgeon is unhappy to refine the reconstruction I would suggest finding a surgeon with expertise in nose reconstruction to assess you for revision surgery. Best of luck.

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.

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, FACSDenver Facial Plastic Surgeon