Reconstructing the Forehead and Glabella After Mohs Surgery

The Role of Skin Flaps in Optimizing Aesthetic Results

Mohs surgery can leave defects on the forehead and between the eyebrows. Strategic skin flaps from adjacent facial areas can help optimize the aesthetic results.

Imagine noticing a small lesion between your eyes, only to learn it’s a basal cell carcinoma requiring Mohs surgery. This procedure progressively removes thin layers of skin until no cancer cells remain under the microscope. Highly effective, yes, but the procedure might still leave a sizable defect.

Even a tiny tumor here may require a large excision on thin forehead skin. Your surgeon explains reconstructive surgery is required to restore this vital facial area.

For substantial forehead and glabella defects after Mohs treatment, skin flaps often provide optimal repairs by using neighboring tissue. But operating between the eyes demands immaculate skill to avoid impacting vision. 

Careful surgical planning and technique are crucial when reconstructing the upper face after Mohs surgery removes skin cancers.

Consult a board-certified dermatologic surgeon to discuss reconstructive options in case larger excisions become necessary. Contact Dermatology & Skin Health today

Why Reconstruction is Crucial After Mohs Surgery?

Mohs surgery is known as a tissue-sparing treatment for skin cancers on delicate areas like the face. It removes cancer in thin layers which are checked under a microscope until all cancer cells are gone. This technique preserves as much healthy skin as possible.

However, Mohs surgery can still leave large defects, especially on the thin forehead and glabella skin which lacks excess. Even small lesions here may require big excisions to get all the cancer. Reasons larger cuts may be needed include:

• Aggressive tumors growing deeper
• Multiple stages to ensure clear margins
• Prior scars requiring extra removal
• Sensitive areas like around eyes and nose
• Irregular tumor shapes

Why Skin Flaps Are Ideal for Forehead and Glabella Reconstruction

For large defects in the upper nose and between the eyes, skin flaps prove advantageous over grafting. Flaps utilize adjacent tissue to fill a surgical site, rotated or advanced into place while retaining their blood supply. Skin grafts involve transplanting skin from elsewhere on the body.

Here’s why skin flaps excel for forehead and glabella reconstruction:

Feature	Flaps	Grafts
Aesthetics	Flaps yield better color and texture matches, critical on the centrally-visible forehead and glabella.	Grafts often look disjointed.
Healing	Flaps maintain their original blood flow for quicker healing.	Grafts must grow new blood vessels.
Versatility	Flaps can fill most defect sizes and shapes in this region.	Grafts work better for smaller, uniform wounds.
Strength	Flaps remain firmly adhered when healed.	Grafts are more prone to displacement or dislodgement over time.

Common Skin Flap Options for the Upper Face and Between the Brows

Several skin flap techniques can successfully reconstruct the forehead and glabella after Mohs:

Advancement Flaps

Advancement flaps use adjacent tissue that is loosened and advanced forward into the defect. They are a top choice for larger forehead and glabella defects due to superior aesthetics compared to skin grafts. 

Rotation Flaps

Rotation flaps rotate nearby skin on a pivot point into the defect. They are validated for moderate-sized to large defects. Rotation flaps can preserve eyebrow symmetry when reconstructing central forehead defects. 

Pedicled Flaps

Pedicled flaps, including forehead and glabellar flaps, transfer skin on a vascular stalk. This maintains blood supply during transposition into the defect. Island paramedian forehead flaps provide single-stage nasal reconstruction. Glabellar flaps effectively restore medial canthus contour.

Flap variations can be designed for optimal tissue movement and minimal tension or distortion on the face.

The Benefits of Skin Flaps for Forehead and Glabella Reconstruction

When large or deep defects result from Mohs surgery on the upper nose or between the brows, skin flaps offer considerable advantages:

Natural Match

Local skin from the forehead or temple region provides the closest match in color, texture, oiliness, and hair-bearing quality to the original facial skin. Skin flaps blend seamlessly into the surrounding tissue.

Favorable Scars

Skillfully designed flaps allow for geometric, well-hidden incisions within the natural creases and contours of the forehead and brow. Strategic flap placement minimizes visible scarring.

Preserved Form

The ample skin laxity and tissue volume of local flaps provide excellent bulk to restore the projecting glabellar ridge and shapely forehead anatomy after tissue removal.

Supple Results

The robust blood supply of skin flaps retains mobility and elasticity for flexible, expressive reconstructed facial areas. Flap surgery restores natural movement.

Quick Recovery

The abundant circulation of skin flaps promotes faster healing, lower risks of complications, and quicker recovery compared to skin grafting procedures. Patients return to normal activity sooner.

Schedule a consultation with our dermatologic surgeon to learn how skin flap can minimize visible scarring and maximize natural contour

What to Expect After Forehead and Glabella Flap Procedures

Patients will need to carefully protect the surgery site and monitor healing during forehead and glabella flap recovery:

• First 72 hours - Swelling, bruising, and numbness peak in severity. Cold compresses, head elevation, prescribed medications provide relief.
• First 1-2 weeks - Sutures are removed. Ointments soften developing scabs. Activity is restricted to limit strain on incisions. 
• 2 weeks to 2 months - Swelling gradually subsides. Incision lines become less pronounced. Numbness slowly dissipates over weeks.
• 3 months - Revision procedures can refine flap contours, scar appearance, and symmetry.
• 6 to 12 months - Most residual swelling resolves. Scars continue maturing and fading. Final cosmetic results fully emerge.

Proper wound care and follow-up facilitates optimal recovery. But due to the delicate eyelid and brow anatomy, patients must follow all surgeon instructions to prevent complications.

Conclusion

Meticulous forehead and glabella flap reconstruction can successfully restore form and function after substantial Mohs defects. However, the eyes require vigilant protection during surgery through optimal flap design and execution. 

With a board-certified dermatologic surgeon, patients can ensure safe, symmetric, natural results in this visually and aesthetically crucial facial region. By prioritizing skin health through provider partnerships and preventive care, individuals can reduce skin cancer risks and feel confident.

Prioritize your skin health and aesthetics. Contact Dermatology & Skin Health to ensure safe, optimal flap reconstruction of any significant forehead or glabella Mohs defects