Cancer Reconstruction

Removal of a skin cancer can leave a significant defect in the face. At Visage Facial Plastic Surgery, we specialize in repairing the delicate structures of the face and can lead you through this process with a caring hand. There are so many options: secondary intention healing, primary closure, skin grafts, local flaps, interpolated flaps. We will advise you as to which repair will be best for you.

Approaches & Techniques

Secondary Intention Healing

This refers to allowing the area to heal on its own with just local wound care. In some areas, this may be a great option. However, as a wound heals, it pulls in all directions, and in some parts of the face, this may cause distortion, asymmetry, and possible functional problems.

Primary Closure

Closing a wound side to side, if possible, is often preferred. To do this, additional incisions often need to be made. In many cases this is not an option because the skin will not stretch without causing distortion elsewhere.

Local Flap

A local flap allows direct movement of adjacent skin to close the wound. Similar to primary closure, additional incisions are required. The difference with primary closure is that the adjacent skin is often rotated or advanced in such a way that the direction of pull is shared in many directions, leading to less risk of distortion. This is usually the best closure technique because it replaces the wound with "like tissue."

Staged Flap

A staged flap uses advanced techniques to "jump" tissue from one area to another. Usually, the wound is in an area that is not well-reached by or is too large for a local flap. A pedicle of tissue is left in place for about 3 weeks before being removed, thus requiring another minor, in-office procedure. A dressing is placed over the pedicle to conceal it during this time. Examples of this are the forehead flap and nasolabial island flap.

Planning Your Procedure

Pre-Operation

Surgery

How It's Done

To perform reconstructive surgery, the "moved" or transplanted tissue must first be released from the surrounding tissue. Deep absorbable stitches are then used to take up the tension of the repair. This minimizes widening of incisional scars. The skin is then usually closed with a combination of absorbable and nonabsorbable stitches.
Duration of Surgery

Reconstruction procedures usually take 1 to 3 hours, depending upon the extent of the wound.
Anesthesia Options

Some procedures may be safely performed in the office with no facility fee, while others are better undertaken at the surgery center.

For healthy patients, many of these procedures may be performed in the office under local anesthesia. For those with major heart and/or lung issues, we perform the procedure at the surgical center, for the patient's safety.
Incisions

Incisions will vary according to the repair method. We do our best to conceal incisions in natural creases and wrinkles.

Post-Operation

Recovery

The typical at-home recovery time is 5-7 days. Immediately after surgery, light compression taping may be used to reduce swelling at the surgical sites. The compression taping is removed in 1-3 days. All stitches dissolve or are removed in 1 week.
Pain
Pain

The first night after surgery, you will feel a dull ache and tightness around the incision sites. Every day thereafter, any discomfort will reduce significantly. It is normal to take opiate medication as needed up to a week after surgery, but most transition to regular Tylenol within the first week.
Swelling & Bruising

Swelling and bruising are expected and mostly subside in the first 2 weeks. Most bruising may be concealed with cover-up as it gradually fades. On average, 90% of the swelling subsides by 6 weeks after surgery, but it will take about 6 months for the incisions to feel soft again. In the end, all swelling and bruising will diminish.