Reconstructive surgery of the nose is one of the most intricate procedures in facial plastic surgery because it requires a balance between restoring function and achieving an aesthetically pleasing outcome. Among the many techniques available, the forehead flap is considered the gold standard for repairing large or complex nasal defects. This method has been refined for centuries and remains widely used because it provides skin that closely matches the nose in color, thickness, and texture. Understanding the forehead flap to reconstruct the nose is essential for medical professionals, patients, and anyone interested in how surgical innovation helps restore both appearance and breathing function.
What Is a Forehead Flap?
A forehead flap is a surgical technique that uses skin and underlying tissue from the forehead to reconstruct the nose. Because the forehead skin shares similar characteristics with nasal skin, it provides an ideal donor site. The flap is designed with its own blood supply, most commonly based on the supratrochlear artery, ensuring good circulation during healing. Surgeons shape and transfer this tissue to cover nasal defects caused by trauma, tumor removal, or congenital deformities.
Why the Forehead Flap Is Commonly Used
Several reconstructive options exist, but the forehead flap stands out for its reliability and aesthetic outcomes. Surgeons prefer it for the following reasons
- It provides skin that blends well with the natural nasal surface.
- The blood supply is strong, reducing the risk of tissue loss.
- It allows reconstruction of large or deep defects that smaller local flaps cannot cover.
- It can be tailored to match specific nasal subunits such as the tip, dorsum, or sidewall.
Indications for Forehead Flap Nasal Reconstruction
The forehead flap is not used for every nasal defect. It is typically recommended in cases where the defect is too extensive for direct closure or smaller flaps. Common indications include
- Defects following removal of skin cancer, such as basal cell carcinoma or squamous cell carcinoma.
- Severe traumatic injuries involving nasal tissue loss.
- Reconstruction after infection or failed previous surgeries.
- Complex defects involving multiple layers of the nose, including cartilage and mucosa.
Surgical Technique
The forehead flap to reconstruct the nose is performed in multiple stages. The staged approach ensures survival of the flap and allows for refinement of the final shape. The key steps include
Stage One Flap Design and Transfer
The surgeon maps out the flap on the forehead, ensuring it is aligned with the supratrochlear artery for reliable blood flow. The flap is then raised and partially detached while leaving its vascular pedicle intact. This tissue is rotated or advanced to cover the nasal defect and carefully sutured into place.
Stage Two Pedicle Division
After two to three weeks, once the transferred tissue has developed its own blood supply, the surgeon divides the pedicle that connects the flap to the forehead. This allows the flap to fully integrate with the nose and frees the forehead for closure.
Stage Three Refinement Procedures
Some patients may need additional surgeries to thin, contour, or adjust the reconstructed area for a natural look. Cartilage grafts are often placed to support nasal structure and maintain airway function.
Healing and Recovery
Recovery after forehead flap reconstruction requires patience because the process is staged and extends over several weeks. Swelling, bruising, and temporary discomfort are common but manageable. Over time, scars fade and the reconstructed nose blends seamlessly with the surrounding facial features. The forehead typically heals with a linear scar that can be concealed within natural wrinkles or hairlines.
Advantages of the Forehead Flap
The forehead flap is highly valued in reconstructive surgery because of its versatility and predictability. Key advantages include
- Excellent cosmetic match for nasal skin color and texture.
- Reliable blood supply that enhances healing.
- Ability to reconstruct both small and very large defects.
- Long-term durability with low complication rates.
Challenges and Limitations
Despite its many benefits, the forehead flap also presents certain challenges. These include
- The need for multiple surgical stages, which may be inconvenient for patients.
- Temporary cosmetic impact due to the pedicle connecting the forehead and nose during healing.
- Potential for forehead scarring, though usually minimal.
- Requirement of surgical expertise to achieve symmetrical and functional results.
Role of Cartilage and Structural Support
In many cases, skin alone is not enough to restore the natural shape and breathing function of the nose. Cartilage grafts, often taken from the ear, septum, or rib, are used along with the forehead flap to provide structure. This prevents nasal collapse and ensures both cosmetic and functional success of the reconstruction.
Psychological and Social Impact
Nasal deformities caused by cancer surgery or trauma can deeply affect a person’s confidence and quality of life. The forehead flap not only restores appearance but also helps patients regain a sense of normalcy. For many, successful reconstruction reduces social anxiety and improves overall well-being.
Historical Background
The forehead flap is one of the oldest reconstructive techniques in surgical history. Records from India in the ancient Sushruta Samhita describe early versions of nasal reconstruction using forehead skin. Over the centuries, the method has been refined with modern anesthesia, improved suturing techniques, and a deeper understanding of vascular anatomy. Today, it remains a cornerstone of nasal reconstruction worldwide.
Modern Innovations
Recent advances have made forehead flap reconstruction even more precise. Surgeons now use imaging techniques, 3D planning, and microsurgical tools to optimize flap design. Combined approaches with other reconstructive techniques, such as free tissue transfer, expand options for patients with the most complex defects.
The forehead flap to reconstruct the nose represents the perfect blend of tradition and modern surgical innovation. It is a time-tested technique that continues to provide outstanding results for patients who require complex nasal reconstruction. Although it involves multiple steps and requires surgical expertise, its ability to restore both form and function makes it the gold standard in nasal repair. For patients facing the loss of nasal tissue due to trauma, cancer surgery, or other causes, the forehead flap offers hope for both functional recovery and renewed confidence in appearance.