A forehead flap is a reconstructive operation for patients who have lost a significant amount of their nose to cancer. Usually any amount of skin loss in greater diameter than 15mm has a higher chance of needing a forehead flap. 15mm is about the diameter of a dime. To most laypeople the operation may at first seem odd, but in actuality it has been a standard operation in the field of facial plastic surgery for decades. The operation is involves reconstructing the missing parts of the nose with skin from the forehead and often cartilage taken from either the nasal septum or from behind the ear. The complete reconstructive process always takes a minimum of 2 operations spaced 3 weeks apart. These operations are often referred to as “stages”. Based on the size of the skin loss more than 2 stages could be necessary.
The second stage of the operation is where we put everything back together. The connection between the forehead and the nose is divided. The skin is contoured to look like nasal skin and both the nose and forehead are stitched fully back together.
Less commonly a third stage is needed. This is most often the case when a significant amount of the nose has been lost to cancer or if the reconstructed area needs further refinement to achieve optimal nasal contouring. If you need a 3rd stage, or more, this will be discussed in detail in your initial consultation. The most stages one patient has needed for an extremely complex and massive loss of the nose was 5-6 stages.
For our patients from out of town we have had excellent success coordinating some of the basic post-op care (such as the removal of stitches) with medical providers in the individual’s home town. For that reason, you need only travel to salt lake city for the operations, but the post op care can be coordinated in your home town with the help of our staff.
The greatest risk from forehead flap surgery is loss of the transferred skin. In hundreds of cases over a 14 year carear a total flap loss has never occurred in dr. Mobley’s patients. A few partial losses have occurred but were seen in the most extreme and complex reconstructive challenges.
When reconstructing the human nose, symmetry is critical. Based on the reconstructive challenges your case presents, as well as your desires, some patients opt for an additional stage so further refinement of the reconstructed nose can be achieved. This may involve thinning down skin that looks a bit thick, correcting nostril asymmetry, or other small detail work to make your nose look as normal as possible. These touch-up procedures are not a risk of surgery; rather, they are a possible, optional operation to get the reconstructed nose to look as much like your original nose as possible.
Everyone knows that experience is one of the most important things to consider when choosing a surgeon. If you have a bad knee you are going to find the orthopedic surgeon in your community that does the most knee surgeries in order to have the best odds for the best possible surgical result. The same concept could not be more true as it applies to nasal reconstruction and specifically forehead flap surgery. However, unlike knee scopes that are common there are simply not as many surgeons trained in complex forehead flap reconstruction across the nation. For that reason, when you choose Dr. Mobley you are training of the current preeminent experts in the field of forehead flap surgery. Think about it, the nose is the center of your face, if you have skin cancer on your nose you want to look as normal as is humanly possible after your reconstruction. Dr. Mobley’s busy practice along with the fact that he trained under world-renowned forehead flap surgeon, Dr. Gary Burget, MD, during his prior training in facial plastic surgery fellowship all help to ensure you that the best odds for the best possible outcome can be achieved.
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