Nasal and Eyelid Reconstruction (rebuilding the nose and eyelid after skin cancer)

Explore nasal and eyelid reconstruction after basal cell skin cancer, nasal surgery, & sculpture of the nose and eyelid by Dr. Michael Bermant, MD plastic & cosmetic surgery.

Michael Bermant, MD
Board Certified by the American Board of Plastic Surgery

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Basal Cell Skin Cancer

Basal cell skin cancer recurrence treated with Mohs' chemosurgery and reconstructed with full thickness skin grafting.

Nasal Reconstruction Mohs' Surgery

 The defect from the front

Lateral View

defect after Mohs' chemosurgery of eyelid and nose plastic and reconstructive surgery Michael Bermant, MD

defect lateral after Mohs' chemosurgery resection of basal cell cancer eyelid and nose 

This patient had basal cell cancer and basosquamous cell cancers previously removed several times in the past by another doctor. She had difficulties with the eyelid tumor sites pulling the lid away from the eye (ectropion) from the earlier operations. When I first saw her it was evident that there was extensive cancer involving the eyelid and nose.

This is an ideal case for Mohs' Chemosurgery. A surgeon (most frequently a dermatologist) fixes the tumor on the patients face with a chemical and then analyses the removed specimen for margins. More tissue is removed until no more tumor is found. Defects resulting from such surgery can be quite extensive as in this case.

 

Nasal Reconstruction Mohs' Surgery

Full thickness skin graft

full thickness skin graft of eyelid and nose after basal cell cancer plastic and reconstructive surgery

A full thickness skin graft was taken from the neck and this is a photograph of suturing it in place. I tried to add enough tissue to prevent an ectropion (pulling of the lower eyelid away from the eye). The black threads were used to tie a dressing in place to stabilize the graft until the tiny blood vessels could grow into the tissue. The smaller brown lines are absorbable suture for additional support.

 

Nasal Reconstruction Mohs' Surgery

Ectropion from front

Lateral View 

ectropion eyelid after skin graft to eyelid and nose after basal cell carcinoma plastic and reconstructive surgery Michael Bermant, MD

ectropion eyelid after skin graft to eyelid and nose after basal cell carcinoma plastic and reconstructive surgery Michael Bermant, MD 

Skin grafts shrink as they heal. Full thickness grafts shrink much less than partial thickness grafts. The neck skin was the closest match in color and texture to the removed tissue in this patient.

 

Nasal Reconstruction Mohs' Surgery

 The defect from the front

Lateral View 

ectropion corrected after full thickness skin grafts for basal cell cancer plastic surgery Michael Bermant, MD  ectropion corrected after full thickness skin grafts for basal cell cancer plastic surgery Michael Bermant, MD

A second skin graft was placed under the eye and the cartilage from the lid was tightened to treat the ectropion. This was done from a blepharoplasty incision just below the eyelashes. Tightening of the eyelid with a blepharoplasty alone would not overcome the forces of the contracting skin graft. The ectropion did not recur after the supplemental grafting.

 

Nasal Reconstruction Mohs' Surgery

4 years after surgery

recurrent skin cancer after basal cell cancer and skin grafts

Notice how nice the grafts look four years after the surgery. The ectropion never recurred. However the lesion on the cheek is a recurrent basosquamous cancer. It extends beyond the grafted area. Even Mohs' chemosurgery can have a recurrence. These cancers are frequently multicentric (occurring in more than one site). Good patient education and close follow-up by your surgeon is usually the best choice. I prefer to see my patients on a regular basis after such cancers. Early detection can mean a smaller operation.

 

Return to Ectropion

Eyelid Cancer and Reconstruction


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