First operation

The cartilage is replaced with a small piece of cartilage taken from the ear. This returns the nostril to its former strengthen.

The skin is now replaced. Skin is used from the forehead with the use of a forehead flap. A strip of skin is cut from the forehead leaving it attached at the eyebrow level - this is the forehead flap. This skin is then folded onto the nose to replace the lost skin of the nose (see line drawing). There is a skin bridge (blue arrow) that must remain for 3 weeks the new forehead skin place on the nose tip.

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Skin and cartilage structure is missing

In this example, the skin and cartilage structure is missing. The framework needs to be replaced.

Second operation

After 3 weeks the new skin of the nasal tip (taken from the forehead) now has a blood supply from the nose. The skin bridge of the forehead flap can safely be divided and removed. This now leaves the reconstructed nose and a fine vertical scar on the forehead. In this case it has resulted in a symmetrical nose with normal nasal breathing, no nostril narrowing or nostril retraction.

Why Do We Do It This Way?

Well we do this because the skin of the nose is limited and when there is a large skin defect on the nose there simply is not enough excess skin on the nose to move into the skin defect without twisting the nose which will result in nasal blockage. So we must find the skin from outside the nose.

Why Use The Forehead Skin?

We use the forehead skin as this has the best colour match and skin texture match for the skin on your nose

Does It Leave Me With A Scar?

Yes there is a vertical scar in the forehead but it heals very well, and for most patients there is no concern about this. Some Ladies will change their hair to a fringe which can easily cover the scar.

Compromise And Choices

Nose reconstruction is about compromise and choices. The nose is far more noticeable than the forehead. So we accept a very faint vertical scar in the forehead in order to get the very best nose reconstruction possible. A correctly performed forehead flap leaves an almost imperceptible scar on the forehead that is rarely troublesome for the patient. 

Forehead flap reconstruction


Dr Callum Faris
ENT doctor and specialist in plastic and reconstitutive facial surgery