CONDITION / FACE

Facial defects after tumor removal.

Facial defects after oncological surgery — loss of skin, soft tissue, cartilage, or bone that remains after tumor removal. They are restored with their own tissues or epithesis — immediately or later, depending on what histology shows.

Discuss your case How it is treated in the clinic ↓

CONCEPTUAL VISUALIZATION

OVERVIEW

What it is: Lack of skin, soft tissue, cartilage, or bone after tumor removal.
When restored: Often in the same operation if the edges are clean; otherwise - after histology.
What: Local flaps, tissues from other parts of the body or epithesis.
Who treats it: A surgeon restores tissues; treatment and supervision of the tumor is carried out by an oncologist.

01 / WHAT IS IT

What is
defect after tumor removal.

The main thing in the treatment of skin cancer is to remove the tumor completely. For squamous cell carcinoma of the skin, the European guideline calls clean incision edges the most important condition for surgery. Therefore, together with the tumor, the surgeon takes away a supply of healthy tissues, and a defect remains on the face.

The defect may be small—a few centimeters of skin on the cheek or nose—or involve cartilage, bone, eyelid, lip, or auricle. Then it is not only the appearance that suffers: the eye may close more poorly, the lip - more difficult to close, the nose - more difficult to breathe.

The goal of reconstruction is to bring the face closer to what it was before the disease and preserve function. If cancer treatment is still ongoing, reconstruction is planned together with the oncologist.

Changes in the face after surgery significantly affect the quality of life. The support of loved ones and specialists and clear information about treatment help to adapt to this.

This is general information. The doctor will tell you what will suit you after the examination.

02 / SIGNS

With what
apply

The consequences depend on where the tumor was and how much tissue had to be removed.

Wound or lack of skin

After the tumor is removed, there is an area that needs to be closed, or it has healed with an indented scar.

Nose

Missing part of wing, tip or back; the nose breathes worse.

Nose defects after removal of tumors

Eyelid and eye

The scar pulls the eyelid down, it turns out or the eye does not close completely.

Ectropion

Lips and mouth

The lip is deformed, the mouth opens or closes worse.

Lip defects

the ear

Part of the auricle is missing after tumor removal.

Loss of auricle

Contour and asymmetry

After major surgery or radiation therapy, the cheek sinks, the tissues are compacted, the face is asymmetrical.

03 / REASONS

It depends on what
reconstruction

How and when the face is restored determines not only the size of the defect.

Type of tumor

Basal cell carcinoma is the most common malignant tumor in fair-skinned people. High-risk tumors and those that have returned are advised to be removed with microscopic margin control.

Basal cell carcinoma of the face

Cut edges

Until histology has confirmed that the tumor has been completely removed, complex reconstruction is often postponed.

Radiation therapy

Irradiated tissue heals worse: in a review of 53 studies, complete loss of the free flap in the irradiated area occurred about 1.6 times more often.

Place and depth

Whether the cartilage, bone, eyelid, lip, or nerve is affected — this depends on the choice of flap and the number of stages.

04 / SEEK MEDICAL ADVICE

When to seek medical advice?

A long-standing defect after an operation that has already healed is a planned situation: it usually does not require emergency care. In the first weeks after surgery, some symptoms require immediate help.

103 immediately if:

bleeding from a wound that cannot be stopped;
the blood is gushing, bright red;
it is very difficult to breathe: a person gasps for air with his mouth, suffocates or cannot utter words;
lips or skin have become very pale, bluish or grey;
after surgery near the eye or on the eyelids, pain in the eye increases, the eye protrudes or has become tense;
after an operation near the eye, the eyelids do not open, diplopia appears or vision deteriorates.

Do not delay a visit to the surgeon:

Immediately - to the surgeon who operated: in the first two weeks after the operation, the flap changed color (darkened, blue or pale), became cold to the touch or tight and tense; if it is not possible to contact the surgeon, go to the reception department. On the same day: the wound is swollen, reddened, it hurts more and more, pus flows from it, you feel bad or have a high temperature. Planned: scars, asymmetry, deformity of the nose, eyelids or lips after healing. If a new nodule, ulcer, or thickening appears at the site of the operation or nearby, tell the oncologist without waiting for the next control examination.

05 / DIAGNOSTICS

As defined,
what to restore

Documents
An extract about the operation, histology with a conclusion about the edges of the incision, data about radiation therapy; photo of the face before the disease, if any.
Review
The size and depth of the defect, the condition of the skin nearby, scars; how the eye closes, the lips close, the nose breathes.
CT or MRI
If bones or deep tissues are affected; bone reconstruction is planned according to the CT scan.
Coordination with the oncologist
Whether the treatment of the tumor is completed, whether radiation therapy is needed and how often to come for control.

06 / TREATMENT

How to restore
the face

The method is chosen according to the size, location and depth of the defect, the condition of the tissues after treatment and the wishes of the patient. Some defects are closed in one operation, complex ones - in several stages.

Immediately or later

Immediately: If the histology confirms clean margins, the defect is often closed in the same operation or in the following days.
Later on: If the edges of the incision have not yet been checked, complex reconstruction is postponed until histology. The systematic review did not provide a definitive answer as to whether the timing of defect closure affects the rate of complications.

Own fabrics

The main way.

Local patches: The skin from the adjacent area is moved to the defect: it is the closest in color and texture. For large areas, the skin stock is first grown with an expander.
Cartilage: Cartilage graft is used to restore the nose, so there are fewer deformations and problems with breathing.
Free flaps: Large defects, in particular with bone, are closed with tissues from other parts of the body, stitching vessels together under a microscope. In a 30-year series of 866 such flaps, 97.6% took root.
Lipofilling: Own fat smoothes the contour and softens tissues after radiation. In a study of 38 patients after treatment for head and neck cancer, 37 reported improvement.

Epithesis

When tissue reconstruction is impossible or undesirable.

What it is: Prosthesis of the ear, nose or part of the eye, which is fixed with glue or on implants in the bone.
How is it holding up?: According to a meta-analysis of 16 studies, epithesis implants did not take root in 3.5% of the ear, 8.8% of the nose, and 18.7% of the eye; the risk is higher in irradiated bone.
satisfaction: In a survey of 71 patients, the most satisfied were those whose epithesis was held on implants. Three quarters said that it does not hurt and there are no problems with it in daily life.
After removal of the upper jaw: On examination, an obturator (a removable prosthesis that closes an opening in the palate) and surgical reconstruction provide a similar quality of life.

Possible complications

general: Infection, dying of wound edges, separation of sutures, hematoma, rough scar.
By plot: Displacement of the eyebrow or hairline, inversion of the eyelid, deformation of the nose, asymmetry, violation of the closing of the lips. Part goes away with time, scars can be repaired again.
Flap: In a review of 34 cases of late free flap loss (after the first week), half occurred on days 7–14. Therefore, the flap is carefully monitored for the first two weeks.

Oncological supervision

After reconstruction: Regular check-ups with the oncologist continue even after the face is restored. How often depends on the type of tumor and risk; long-term surveillance is recommended for high-risk basal cell carcinoma.

07 / AT THE VALIKHNOVSKYI INSTITUTE

How
we treat it.

Facial defects after oncological operations are restored at Dr. Valikhnovskyi's Institute of Surgery in the "New Face" direction. Reconstruction is often done in one operation with removal of the tumor, if the edges of the incision are clean; otherwise - after histology. The clinic is responsible for removal and reconstruction; Chemo-, immuno-, and radiation therapy and oncological supervision are conducted by an oncologist.

CLINIC SERVICE A new face Form, symmetry, facial expressions and functions after injuries, wounds, burns, removal of tumors and congenital changes. View service

What we do for this condition

Local patches — nasolabial, cervicofacial, and frontal flaps cover small and medium-sized defects with tissues that are similar in color and texture.
Perforating facial flaps — a flap of skin on a thin vascular pedicle closes the wound without gross tension and distortion of the lines of the mouth or eyes.
Fabric dermotension (expander) — next to the defect, a supply of healthy skin is grown for 1–3 months, and then it is moved to the defect.
Free microsurgical flaps — fibula flap for jaw, radial forearm flap for lips and cheeks, anterolateral thigh flap for large defects.
Virtual planning and 3D printing — based on a CT scan, bone reconstruction is planned, templates and individual implants are printed.
Lipofilling — micro- and nanofat correct the contour after major reconstructions and can improve scars, in particular after radiotherapy.

Rostislav Valikhnovskyi

Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.

About the doctor ORCID

How treatment works with us

Photo onlineSend a photo of the face, an extract about the operation and histology.
ConsultationInspection of the defect, evaluation of documents; if necessary — CT scan and consultation with an oncologist.
PlanHow to close the defect, immediately or later, how many stages will there be.
ReconstructionFlaps, expander, cartilage or fat - depending on the defect.
RecoveryThe first two weeks — careful care of the flap; then - examinations by a surgeon and an oncologist.

Discuss your case Call

08 / QUESTIONS AND ANSWERS

Common
questions

Short answers. What is right for you, the doctor will tell you during the consultation.

Is it possible to restore the face immediately after removing the tumor?

Often yes, if histology confirms that the tumor has been completely removed. If the edges of the incision have not yet been checked, the complex reconstruction is postponed.

Will the flap hide the recurrence of the tumor?

Therefore, they are not in a hurry with a complex reconstruction until clean edges have been confirmed. After the reconstruction, regular check-ups with the oncologist continue; show new nodules or ulcers to the doctor without waiting for a routine examination.

Is it possible to do reconstruction after radiation therapy?

Yes, but irradiated tissues heal worse, and the risk of complications is higher. This is taken into account when choosing a method.

Which is better — own tissue or epithesis?

Depends on the defect, tissue condition and general health. Own tissues become part of the face; epithesis helps when reconstruction is impossible or undesirable. Decisions are made together with the patient.

How many operations will be needed?

A small defect is often closed in one operation. Large ones - in several stages, and scars and contour may need correction later.

Can the unsuccessful result of the previous reconstruction be corrected?

It is possible: the scars are cut out, the contour is adjusted with fat, the deformity is corrected by repeated surgery. What is possible for you, the doctor will tell after the examination.

09 / SOURCES

Sources

16 sources · European guidelines, systematic reviews, cohorts and NHSshowCollapse

European consensus-based interdisciplinary guideline for diagnosis and treatment of basal cell carcinoma-update 2023European Journal of Cancer, 2023doi:10.1016/j.ejca.2023.113254 ↗
European consensus-based interdisciplinary guideline for invasive cutaneous squamous cell carcinoma: Part 2. Treatment-Update 2023European Journal of Cancer, 2023doi:10.1016/j.ejca.2023.113252 ↗
Time to Mohs Reconstruction: A Systematic Review Comparing Complication Rates between Immediate and Delayed RepairFacial Plastic Surgery, 2024doi:10.1055/a-2112-7073 ↗
Complications in facial Mohs defect reconstructionCurrent Opinion in Otolaryngology & Head and Neck Surgery, 2017doi:10.1097/MOO.0000000000000375 ↗
Head and neck reconstruction using free flaps: a 30-year medical record reviewArchives of Craniofacial Surgery, 2021doi:10.7181/acfs.2020.00745 ↗
Effect of preoperative radiation on free flap outcomes for head and neck reconstruction: An updated systematic review and meta-analysisJournal of Plastic, Reconstructive & Aesthetic Surgery, 2022doi:10.1016/j.bjps.2021.09.050 ↗
Late free flap failure in head and neck reconstruction: A systematic reviewEar, Nose & Throat Journal, 2018doi:10.1177/014556131809700712 ↗
Flap Monitoring and Postoperative ICU Care after Microsurgical Head and Neck ReconstructionSeminars in Plastic Surgery, 2025doi:10.1055/s-0045-1814139 ↗
Implant failure of facial prostheses: systematic review and meta-analysisInternational Journal of Oral and Maxillofacial Surgery, 2025doi:10.1016/j.ijom.2025.03.016 ↗
Patients' satisfaction with facial prosthesesBritish Journal of Oral and Maxillofacial Surgery, 2016doi:10.1016/j.bjoms.2015.09.011 ↗
Comparative analysis of surgical and prosthetic rehabilitation in maxillectomy: A systematic review and meta-analysis on quality-of-life scores and objective speech and masticatory measurementsJournal of Prosthetic Dentistry, 2025doi:10.1016/j.prosdent.2023.11.023 ↗
Evaluation of the efficacy of lipotransfer to manage radiation-induced fibrosis and volume defects in head and neck oncologyHead & Neck, 2019doi:10.1002/hed.25888 ↗
Factors affecting quality of life in patients experiencing facial disfigurement due to surgery for head and neck cancerBritish Journal of Nursing, 2019doi:10.12968/bjon.2019.28.3.180 ↗
Treatment for non-melanoma skin cancerNHS, 2026nhs.uk/conditions/non-melanoma-skin-cancer/treatment ↗
Cuts and grazesNHS, 2026nhs.uk/conditions/cuts-and-grazes ↗
Shortness of breathNHS, 2024nhs.uk/symptoms/shortness-of-breath ↗

The figures on the page are from these sources.

VALIKHNOVSKI SURGERY PARTNERS

After removing the tumor
left a defect?

Send a photo of the face, an extract and a histology. The doctor will tell how and when the tissue can be restored.

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