The nasolabial flap uses the generous, well-supplied skin of the cheek beside the nose, along the fold that runs from the corner of the nostril to the corner of the mouth. That fold, the nasolabial crease, is the reason the technique works so well: the scar left behind sits inside a line the face already has.
Nasolabial flaps are a mainstay of nasal reconstruction after skin cancer removal, particularly for defects of the ala, the curved outer wall of the nostril. Miss Rakhee Nayar is dual-trained in Mohs micrographic surgery and plastic surgery, so the flap is planned by the same consultant who removed the tumour.
When a nasolabial flap is used
- Defects of the nasal ala or the side wall of the nose, most often after removal of a basal cell carcinoma.
- Wounds needing both surface cover and some bulk to rebuild a natural curve.
- Situations where a skin graft would leave a flat, mismatched patch on a curved, prominent part of the face.
- Defects of the upper lip and the floor of the nostril.
One stage or two
Some nasolabial flaps are completed in a single operation. Others are pedicled, meaning the flap stays attached to the cheek by a bridge of tissue carrying its blood supply while it settles into its new position. That bridge is divided in a short second procedure, usually about three weeks later, once the flap has established its own circulation.
A two-stage approach is more inconvenient but often gives a better contour on the nostril rim. Which route is right is discussed with you before surgery.
What the procedure involves
The flap is designed and marked along the nasolabial fold, raised with its blood supply protected, and moved into the nasal defect where it is stitched in layers. The cheek is closed directly, leaving a fine line within the fold. Most nasolabial flap surgery is carried out under local anaesthetic as a day case.
Healing week by week
- Days 1 to 5. Swelling and bruising around the nose, cheek and sometimes the eye. The flap looks bulky and pink.
- Days 5 to 10. Stitches removed. Swelling starts to reduce.
- Week 3. If the flap is pedicled, the bridge is divided at this point.
- Weeks 4 to 12. Bulkiness settles gradually. The nostril contour becomes clearer as swelling resolves.
- Months 3 to 12. Scars pale and soften. A minor thinning or contour refinement is sometimes offered at around six months.
Results
Because cheek skin is a close match for the skin of the nose in colour, thickness and oil content, a well-executed nasolabial flap tends to blend far better than a graft in this location. The trade-off is a longer operation, more early swelling and, in pedicled cases, a second visit.
Book a consultation
To discuss Mohs surgery and 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.