What is a Paramedian Forehead Flap?
One of the most common ways to reconstruct the nasal tip is a flap known as the paramedian forehead flap. This uses skin and its blood supply borrowed from the forehead to replace lost skin of the nasal tip.
What does a Paramedian Forehead Flap look like?
The above example demonstrates the appearance of a paramedian forehead flap. This was used to recreate a nasal tip defect from skin cancer. There are two stages to this flap reconstruction. First step – rotate the forehead flap into place. This contains a flap of skin and its blood supply from the forehead. This is sewn into place over the nasal defect. The middle image demonstrates a finger-like connection between the patient’s eyebrow and the tip of the nose. This stays in place for approximately 4 weeks while new blood vessels grow from the nose into the forehead skin. The second step is to divide the flap blood supply and return excess skin back to the forehead while leaving the new skin on the tip of the nose.
What happens to the forehead when using a Paramedian Forehead Flap?
The forehead in most cases has enough elasticity that it can be closed easily. This heals up with a thin vertical scar that is about 4 inches long.
What are other options besides Paramedian Forehead Flaps for nasal tip defects?
There are other options for reconstructing the nasal tip including skin grafts, flaps taken from the cheek, and local flaps from the nose. The options are determined by the size of the defect and if the underlying cartilages are involved or if the inside lining of the nose is involved (which would require closure at the same time). I discuss all possible options with my patients prior to surgery. Closure using a paramedian forehead flap does allow similar thickness and color-match skin for an excellent cosmetic and functional result.
Should I have a facial plastic surgeon close my skin cancer defect?
I work closely with many Mohs surgeons in the DFW area for closure of nasal and facial skin cancer defects. I recommend patients with skin cancer of the face or neck see me prior to removal of skin cancer. This allows us adequate planning for the most streamlined process possible – often performing the closures on the same day as the removal!
Please do not hesitate to contact me with any questions and check our Facial Reconstruction page for more examples!