Forehead Flaps

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.

Typically in the first stage a strip of skin from the forehead is brought down to the nose but is kept connected to the forehead through a strip of connecting tissue. Often parts of the tip of the nose must be reconstructed by using cartilage taken from behind the ear. This does not significantly change the shape of the ear. This strip of forehead skin must then stay attached for 3 weeks (click for image). This is the length of time necessary to establish a proper blood supply to the piece of skin being transferred. Understandably, this can be a difficult time of being out in public for many patients.

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.

Forehead flaps are usually performed on an outpatient basis. Some patients are kept overnight in the hospital after the first stage but this is not common. While patients can look a bit “ghoulish” for the 3 weeks following the first operation, they can go back to normal activity levels rather quickly. In my patients one of the main limitations I have seen is that it can be difficult to wear eyeglasses for the 3 weeks following the first stage. Obviously, most patients choose to avoid major social engagements for the 3 weeks following the first stage. Recovery from the second stage is much quicker. Patients can go back to light activities a few days after surgery and can usually easily be back at work 3-7 days after the second stage.

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.

Like any reconstructive surgery, the most common risks are bleeding, infection and poor wound healing. Unless you have diabetes or other health condition, the risks for poor wound healing are fairly low given the arterial pedicled blood supply to the forehead skin that is transferred to your nose. Dr. Mobley has had a very few partial losses of skin over a 20+ year career and have only occurred in the most “top tier” 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.

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.

Dr. Mobley wants to make reconstructive surgery available to as many people as possible. There are several options for financing your surgery that may work best for you, including:

1. In many cases, Forehead Flaps surgery can be covered by insurance. Click here to view our welcomed insurance plans.
2. Your health insurance may have an “out of network” option. When you see Dr. Mobley out of network you will likely share in a greater financial responsibility for Dr. Mobley’s fees. However, many out of network options will still allow part of your anesthesia, lab, and OR fees to be covered more completely by your insurance company. Click here to learn more about out of network surgery.
3. At Mobley MD, we offer surgery financing options through CareCredit and GreenSky, the nations largest surgery financing providers. Please view our Financing page for more information.