The paramedian forehead flap brings skin down from the centre of the forehead to rebuild the nose, staying attached to a narrow pedicle carrying its blood supply from just above the inner eyebrow. It is the oldest recorded reconstructive operation in surgery and it remains the gold standard for rebuilding large defects of the nose.
Forehead skin is the closest available match to nasal skin in colour, thickness and texture, and the flap carries a robust blood supply. That combination is why a forehead flap to the nose still outperforms every alternative for substantial defects.
When a forehead flap is used
- Large defects of the nose after Mohs surgery, particularly those involving the tip.
- Defects crossing more than one aesthetic subunit of the nose.
- Full-thickness defects where lining, support and surface cover all need rebuilding.
- Cases where a nasolabial flap or a graft would not provide enough tissue.
A staged operation
The forehead flap is deliberately carried out in stages, usually two and sometimes three, spaced roughly three weeks apart.
- Stage one. The flap is designed on the forehead, raised, rotated down and stitched into the nasal defect. The pedicle remains attached and visibly bridges between forehead and nose during this period. The forehead donor site is closed directly, with any small area that cannot be closed left to heal naturally.
- Stage two, about three weeks later. Once the flap has developed its own blood supply from the nose, the pedicle is divided and the base tidied back into the eyebrow area.
- Stage three, if needed. A later thinning and contouring procedure to refine the shape.
The interim period, when the pedicle is still in place, is the part most patients find hardest. It is temporary, and it is discussed fully with you beforehand so there are no surprises.
Healing and recovery
- Weeks 1 to 3. Swelling and bruising around the nose, forehead and eyes. The pedicle is dressed and cared for daily.
- Week 3. Pedicle division. Immediate improvement in appearance.
- Weeks 4 to 12. Swelling settles and the shape of the nose emerges. The forehead scar is red at this stage.
- Months 3 to 12. Contour refines and scars pale. The vertical forehead scar typically fades to a fine line.
Results
For large nasal defects, a forehead flap gives a result no graft can approach, restoring both the surface and the three-dimensional shape of the nose. It asks more of the patient in time and in the appearance of the interim stage, which is exactly why the decision is made carefully and together.
Book a consultation
To discuss nasal reconstruction with Miss Nayar, please use the contact form or call the clinic directly.
Book a consultation
If you are facing Mohs surgery and want to understand how your wound would be repaired, this is exactly what a consultation covers. Bring your referral letter or biopsy result if you have one.