The skin
Superficial defects - when the tumor has not affected the cartilage.
CONDITION / CARRY
Nose defect after removal of the tumor.
Nasal defect after tumor removal — a wound or loss of part of the nose after surgery for skin cancer. Small defects are sutured or closed with a local flap, large ones with a frontal flap, restoring both the skin and the frame.
CONCEPTUAL VISUALIZATION- what is it
- A wound or loss of nasal tissue after removal of a skin tumor.
- What to close
- Flaps (42%), simple suturing (28%) and skin grafting (25%) — according to a review of 111 studies.
- Large defects
- More than 1.5 cm is most often restored with a frontal flap.
- Who treats
- A surgeon who performs reconstructive operations on the nose.
01 / WHAT IS ITWhat is a
What is a
nasal defect.
The nose is one of the most common sites of facial skin cancer, especially basal cell carcinoma. After the removal of the tumor with a reserve of healthy tissue, a wound of various sizes and depths remains: from a small area of skin to the loss of part of a wing, tip or back along with cartilage.
The reconstruction should restore both appearance and function of the nose: so that the skin is suitable in color and thickness, and the nostrils do not narrow and do not collapse during inhalation.
Surgeons divide the nose into aesthetic sections — the back, side walls, tip, and wings. The choice of method depends on which area is affected and how deeply.
This is general information. The doctor will tell you which method is right for you after the examination.
02 / SIGNSWhat is restored
What is restored
after the operation.
Defects vary in size, depth and location. In the series of 419 patients, the back and side walls were most often restored (66.35%).
the tip
An area with thicker, dense skin, where it is important not to distort the shape.
wing
Here it is important that the nostrils do not collapse during inhalation.
Through defect
Loss of skin, cartilage, and inner lining requires restoration of all three layers.
Consequences of ancient operations
Scars and asymmetry after previous reconstruction.
Repeated operations on the nose03 / REASONSWhere do
Where do
defects come from.
Most nose reconstructions are performed after removal of skin cancer, in particular, Moss surgery — layer-by-layer removal with control of the edges under a microscope.
Basal cell carcinoma
The most common tumor of the skin of the nose.
Basal cell carcinoma of the faceOther tumors
Squamous cell cancer, melanoma, sometimes tumors hiding under rhinophyma.
RhinophymaPrecancerous changes
Removing skin changes before they become cancerous also leaves a wound.
Precancerous skin changes
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
Reconstruction is usually planned in advance — together with or after tumor removal. Urgency is needed if the wound does not heal well after the operation.
103 immediately if:
- bleeding from the wound does not stop after 15 minutes of pressure.
To the surgeon on the same day, if:
The wound after removal of the tumor or reconstruction has become red, swollen, pus has appeared, the temperature has changed or the flap has changed color. If the wound has healed, but you are concerned about the shape of the nose or breathing, make an appointment for a scheduled consultation.
05 / DIAGNOSTICSHow they plan
How they plan
reconstruction.
- The result of histology
Reconstruction is done when the edges of the removed tumor are clean.
- Evaluation of the defect
The size, depth, area of the nose, whether the cartilage and inner lining are affected.
- Donor plots
Where to get skin and cartilage: cheek, forehead, ear, rib.
- Plan of stages
Is one operation enough, or are two or three stages necessary?
06 / TREATMENTHow to restore the
How to restore the
nose.
The evidence base here is mainly from cohort series, so the choice of method is based on the experience of the surgeons and the location of the defect.
01
Small and medium defects
- Local patches
- The skin is shifted or turned from the adjacent area of the nose. A bilobed flap is often used at the tip: in a series of 125 patients, complications, in particular scarring and difficulty breathing, were in 16%, re-correction was required in 4%.
- Nasolabial flap
- For the wing of the nose: in a series of 111 patients, it was used most often, with the highest rating of 7 out of 10 among the methods.
- Skin grafting
- Full-layer skin graft — according to a review of 111 studies, it covered a quarter of defects (25%); in one of the areas of the nose it was the most frequent method.
02
Large defects
- Frontal flap
- The skin is cut out on the forehead on the vascular peduncle and moved to the nose; after a few weeks, the leg is cut off. Defects over 1.5 cm are most often closed in this way.
- Cartilage
- Cartilage grafts can reduce deformity and difficulty breathing.
- Phasedness
- The forehead flap gives higher satisfaction with the appearance, but more often requires additional stages of correction.
03
Risks
- Complications
- After two-stage flaps, 169 patients had 23 complications (13.61%), most often bleeding (5.33%); after cutting off the leg — in 3.55%, most often infection.
07 / AT THE VALIKHNOVSKY CLINIC
How do we
How do we
treat it.
Defects of the nose after the removal of tumors at Dr. Valikhnovsky's Institute of Surgery are restored in the "New Nose" direction - from reconstruction of the wings, tip or back to three-layer reconstruction for large defects.
DIRECTION TO THE CLINIC
A new nose
Shape, support and breathing of the nose: septum, concha, sinuses, consequences of injuries, failed operations and removal of tumors.
Go to direction
What do we do in this condition
- Paramedian frontal flap — the main method of skin restoration for large and complex defects.
- Cartilage grafts — the patient's own cartilage of the ear or ribs for the framework of the nose.
- Expander dermotension — preliminary stretching of the forehead skin, if it is missing.
Rostislav Valikhnovsky
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovsky Institute of Surgery.
Publications by topic
- Article on the principles of diagnosis and treatment in reconstructive surgery of acquired nasal defects — Clinical Surgery, 2009 (PubMed).
How is the treatment in us
- Documents onlineSend a photo and a histology report - the doctor will pre-evaluate the defect.
- ConsultationInspection of the defect and donor sites.
- PlanMethod, number of stages, where to take skin and cartilage.
- OperationReconstruction — in one or several operations.
- RecoveryFlap healing and subsequent stages; the final form is formed gradually.
08 / QUESTIONS AND ANSWERSFrequently asked
Frequently asked
questions.
Short answers. What is right for you, the doctor will tell you during the consultation.
When can reconstruction be done after tumor removal?
When the edges of the removed tumor are clear histologically. Sometimes the reconstruction is done immediately, sometimes in a separate stage.
Will there be a scar on the forehead after a frontal flap?
Yes, a vertical scar remains on the forehead; it usually becomes less noticeable over time. The skin of the forehead matches the nose well in terms of color and thickness.
How many operations are required?
Small defects - one operation. Frontal flap — at least two stages: transfer and cutting off the pedicle; sometimes additional corrections are required.
Which is better: skin graft or flap?
In a study of 144 reconstructions, local and frontal flaps were more likely to receive a good appearance rating than skin grafts. But the choice depends on the location and size of the defect.
Is it possible to restore the nose if a large part is lost?
Yes, a three-layer reconstruction: inner lining, cartilage framework and skin. These are several stages.
Can there be complications?
Yes: bleeding, infection, separation or necrosis of wound edges, rough scars. Their risk is reduced by careful technique and post-operative control.
Sources
10 sources · reviews, guidelines and studiesShowCollapse
- Nasal reconstructive techniques following Mohs surgery or excisions: a systematic reviewArchives of Dermatological Research, 2023doi:10.1007/s00403-022-02390-8 ↗
- A Systematic Review and Overview of Flap Reconstructive Techniques for Nasal Skin DefectsFacial Plastic Surgery & Aesthetic Medicine, 2021doi:10.1089/fpsam.2020.0533 ↗
- Nasal Alar Subunit Reconstruction: A Review of DataLaryngoscope Investigative Otolaryngology, 2026doi:10.1002/lio2.70494 ↗
- Aesthetic Outcomes of Nasal Reconstruction Following Mohs ExcisionAnnals of Plastic Surgery, 2025doi:10.1097/SAP.0000000000004211 ↗
- Outcomes and Complications of 2-Stage Versus 3-Stage Paramedian Forehead FlapsOtolaryngology–Head and Neck Surgery, 2025doi:10.1002/ohn.1210 ↗
- Postoperative Complications After Interpolated Flap Repair for Mohs Defects of the Nose: A Multicenter Prospective Cohort StudyDermatologic Surgery, 2023doi:10.1097/DSS.0000000000003653 ↗
- The Bilobe Flap for Nasal ReconstructionFacial Plastic Surgery, 2020doi:10.1055/s-0040-1712160 ↗
- Nasal Reconstruction: A Simplified Approach Based on 419 Operated CasesAesthetic Plastic Surgery, 2015doi:10.1007/s00266-014-0417-0 ↗
- Reconstruction of nasal ala and tip following skin cancer resectionArchives of Craniofacial Surgery, 2019doi:10.7181/acfs.2019.00486 ↗
- Complications in facial Mohs defect reconstructionCurrent Opinion in Otolaryngology & Head and Neck Surgery, 2017doi:10.1097/MOO.0000000000000375 ↗
The figures on the page are from these sources.
After removal of
tumor.
Send a photo of the defect and a histology report. The doctor will tell you how to restore the nose and how many stages will be needed.