Nasal Reconstruction After Skin Cancer

This 64-year-old man was diagnosed with an aggressive basal cell carcinoma that involved nearly the entire nose. The cancer destroyed most layers of skin down to the cartilage, leaving him with a large, full-thickness defect of the nasal dorsum and sidewalls following Mohs micrographic surgery.

To reconstruct the nose, Dr. Salvatore Pacella — San Diego’s leading expert in facial and nasal reconstruction — performed a classic three-stage paramedian forehead flap, one of the most advanced techniques for complex nasal defects.

• Stage One: Flap Creation and Structural Reconstruction
  A vascularized flap of skin was harvested from the forehead and transposed to the nose to cover the defect. Structural support was rebuilt using cartilage grafts to restore the nasal framework and preserve the airway.
• Stage Two: Sculpting and Contour Refinement
  After initial healing, the flap was sculpted and contoured to match the natural shape of the nose, blending it seamlessly with the surrounding tissue.
• Stage Three: Final Refinement and Detachment
  In the final stage, the flap was detached from the forehead and fine-tuned to ensure optimal aesthetics, symmetry, and nasal function.

At one year post-op, the patient’s nose appears remarkably natural in both shape and texture, with minimal visible scarring. He enjoys full nasal function and breathing without obstruction. Patients across San Diego and Southern California routinely seek Dr. Pacella for this level of reconstructive expertise following Mohs surgery for skin cancer.