The Condition
The nose is the most common site for non-melanoma skin cancer. MOHS micrographic surgery and wide local excision are standard oncological treatments but leave defects ranging from small superficial wounds to full-thickness composite defects. Trauma, burns and previous surgery may also require complex reconstruction. The nose has highly specialised subunit anatomy, skin characteristics and functional requirements (airway, nasal valve).
Reconstructive Options
Primary closure: For small defects with adequate skin laxity.
Secondary intention healing: Selected concave defects of nasal alar groove and medial canthus heal with excellent cosmesis by secondary intention.
Full-thickness skin graft (FTSG): Pre- or post-auricular skin provides excellent colour and texture match for small nasal defects.
Local flaps: Bilobed flap, rhomboid flap, nasolabial flap — used for moderate defects of the nasal tip, ala and sidewall. Concealed incisions, single stage.
Paramedian forehead flap: The workhorse for large nasal defects, particularly full-thickness. A staged procedure (typically 2–3 operations) using forehead skin — the closest tissue match in quality and colour. Provides durable, natural results.
Composite grafts: Full-thickness grafts including cartilage (from ear) for alar margin reconstruction.
All excised tissue is routinely sent for histological analysis. This is standard practice charged separately by the laboratory. Results available within 7–14 days.
Risks & Complications
All surgery carries risk; these are discussed fully at your consultation, alongside the specific reconstructive option planned for your defect.
Partial Flap or Graft Loss
Uncommon; risk is higher in smokers and at the tip of longer flaps, where blood supply is more marginal. May require a further small procedure.
Bleeding / Haematoma
Uncommon; meticulous haemostasis and, where used, a supportive dressing minimise this risk.
Infection
<2%. Prophylactic antibiotics given where appropriate.
Contour Irregularity
Some visible step or fullness at the reconstruction site is common initially and often settles with time; occasionally a secondary revision or thinning procedure is planned from the outset.
Altered Sensation
Temporary numbness around the reconstructed area; usually improves over weeks to months.
Scarring
Incisions are planned within nasal subunit boundaries where possible to minimise visibility; scars continue to soften for up to 12 months.
Aftercare & Recovery
- Dressings reviewed at 48 hours and 1 week
- Sutures removed at 5–7 days (face)
- Avoid blowing nose for 2–4 weeks
- Spectacles: may need to be taped rather than rested on nose for 4–6 weeks
- Return to office work: 1–2 weeks
- Exercise: light at 2 weeks; strenuous at 4–6 weeks
- Sun protection of scars: minimum 6 months; SPF50+ mandatory
Alcohol impairs platelet function, increases bleeding risk, interferes with anaesthesia, and impairs wound healing. Abstain for at least two weeks before and after surgery.
Nicotine (cigarettes, vaping, patches, gum) dramatically increases risk of wound breakdown and poor scarring. Minimum six weeks nicotine-free before and after surgery.
Face sutures removed at 5–7 days; body sutures at 10–14 days. Absorbable sutures require no removal. You will be clearly advised which type has been used.
Micropore tape reduces scar tension. Silicone tape/sheets commence at 2–4 weeks. Prineo mesh dressing used for longer incisions. Avoid direct sun on scars for 6 months; SPF50+ mandatory.