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Treatments and Procedures: Complex Facial Reconstruction

Facial plastic surgery is an essential consideration for patients with advanced skin cancer of the face and neck, as well as those affected by traumatic injury to these areas. Diagnosing advanced skin cancer of the face and neck through biopsy--and removing it completely--can involve extensive tissue loss.

Addressing advanced facial skin cancer and severe facial trauma calls for special skills to restore form and function to the structures of your face. The Facial Plastic and Reconstructive Surgery team offers unparalleled skill and compassion to help patients with even the most challenging facial skin cancers and facial injuries.

Scott's Story: Combat Veteran's Complex Microsurgical Facial Reconstructive Surgery

After a bomb blast destroyed the bones of his face and jaw when he was serving in Somalia, Scott had 9 unsuccessful surgeries and was unable to eat solid food for 25 years. Scott consulted with facial and reconstructive surgeon Shaun Desai, M.D. who rebuilt his jaw from Scott's fibula bone using innovative technology with 3D printing and virtual surgical planning.

 

Advanced Facial Skin Cancer: Why Choose Johns Hopkins Facial Plastic Surgery?

  • Our team's skill and the large number of patients we see helps us address even the most complex skin cancers of the face, including melanoma, advanced basal cell and squamous cell carcinoma as well as Merkel cell carcinoma.
  • We have extensive experience in performing a high volume of sentinel lymph node biopsies of the head and neck. We work with our nuclear medicine colleagues in the radiology department to precisely identify head and neck sentinel lymph nodes, which allows for minimally invasive incisions — essential to addressing the cosmetically sensitive area of the face and neck.
  • Every facial skin cancer removal procedure is carefully planned with reconstruction in mind. 

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Surgery for Advanced Skin Cancer: What to Expect

Biopsy

Biopsy results are very important for melanoma and other advanced skin cancers of the face. The thickness, or depth of the cancer’s penetration into the skin’s layers, determines the margins — how much normal-appearing skin around the melanoma should be removed.

Depending on the biopsy results, we may also recommend that you undergo a sentinel lymph node biopsy, which tests the lymph node(s) close to the cancerous area and determines if the cancer has spread.

All cases of melanoma, Merkel cell carcinoma and advanced skin cancers are discussed at the Johns Hopkins Multi-disciplinary Cutaneous Malignancy Tumor Board.

Surgery to Remove the Cancer

You must get a preoperative physical exam within 30 days of your surgery date. You can arrange for the physical with your primary care physician or at the preoperative clinic at Johns Hopkins. Depending on your medical history, you may also need an anesthesia evaluation before your procedure.

Surgery is generally performed at an ambulatory surgery center as an outpatient, which means you can go home the same day. Depending on your general health, the surgery may take place in the hospital.

After the surgeon removes the cancerous tissue and surrounding margins, he or she will check carefully to see that no cancer remains. You will have bandages over the defect—the area where skin was cut away—to ensure the area stays clean until reconstruction.

Reconstructing the Face

For facial reconstruction, your surgeon’s goal is to achieve the best function and appearance possible. If only a small amount of tissue is removed, your surgeon may simply let the wound heal. However, for most advanced cancers, thorough removal of all the cancer and its surrounding skin may leave a substantial defect (area of missing tissue).

Your surgeon may repair the defect with a flap, which is a section of skin or tissue from a nearby area cut away, stretched and then moved to cover the defect. Or, you may require a skin graft, which involves a patch of skin removed from another part of the body and grafted onto the defect.

Some reconstructions require more than one operation: one to prepare the flap and move it into place, and another to smooth and sculpt the tissue for optimal function and appearance.

Risks

All procedures involve a certain amount of risk and limitations. Although the risks of skin cancer reconstruction are low, they can occur: Bleeding, infection, numbness, facial weakness, delayed wound healing, less-than-optimal appearance and other problems may occur. The risks are significantly increased in patients who smoke or those with a history of radiation therapy applied to the face, head or neck.

After Surgery

If your surgeon uses a skin graft for reconstruction, you will have a special bandage called a bolster dressing in place, which requires removal seven to 10 days after surgery.

Some patients return to work a week or two after their first postoperative visit. However, if you are undergoing a flap procedure or other approach that requires multiple stages, you will likely want to take off several weeks from work.

When your procedures are complete, your scar(s) will be red at first, and the redness will gradually fade over the course of one year. Protecting your face from sun exposure and using sunscreen are critical for minimizing lasting discoloration.

Our Physicians

Our doctors are uniquely dual board certified in both otolaryngology — head and neck surgery and facial plastic and reconstructive surgery, which gives our team a unique and comprehensive level of expertise.

Nasal Tip Surgical Reconstruction: Options After Mohs Surgery

Learn about three options for nasal tip reconstruction following Mohs surgery: local flap, skin graft and forehead flap, from Johns Hopkins facial plastic and reconstructive surgeon Patrick Byrne.

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