The forehead flap rebuilds a missing part of the nose using skin from the middle of the forehead. It is done in stages, and for a few weeks a strip of tissue runs visibly from the eyebrow down to the nose before it is divided.
A forehead flap rebuilds the nose using skin from the forehead, carried down on a narrow strip of tissue that keeps its blood supply alive. The flap is set into the nose at the first operation, left connected for a few weeks, then divided and refined at a second sitting. It remains the standard choice for large nasal defects.
Skin from the middle of the forehead is thick, slightly oily and close in colour to the skin of the nose, so it is the best available substitute when a large piece of the nose is missing. Surgeons mark a paddle of forehead skin above the eyebrow, raise it with the tissue beneath, and swing it downwards on a narrow strip that carries its artery. That strip is the pedicle, and it is what allows skin from so far away to survive the journey.
Staging is not an inconvenience, it is the safety of the operation. While the pedicle remains attached, the flap keeps its original blood supply. Over the following weeks the transferred skin grows fresh vessels in from the edges of the nasal wound. Only once that has happened is the pedicle divided, which normally takes place after about three weeks.
Rebuilding a nose usually means rebuilding three layers. Cartilage taken from the ear or rib provides the framework that keeps the nostril open, a lining flap forms the inner surface, and the forehead flap supplies the outer skin. Further small refinements are common at later sittings.
This flap is reserved for defects too large or too deep for local tissue to cover. It asks patience of the patient, and that has to be discussed honestly.
The defect is cleaned and shaped, and a template is made of the missing area. Lining is rebuilt and cartilage grafts are placed to hold the nostril open and support the new skin.
A paddle of skin is marked on the forehead to match the template and lifted with its pedicle. The vessel is traced towards the inner eyebrow so the flap can reach without tension.
The flap is turned down over the nose and stitched into place layer by layer. Its pedicle stays exposed, bridging from brow to nose, and is dressed to keep it moist and protected.
Most of the donor area is closed directly. A small upper portion is sometimes left to heal on its own, and it usually fills in and pales over several months.
After about three weeks the pedicle is divided under local or general anaesthesia. Its base is returned to the brow, the nose is thinned and contoured, and further refinements follow later if needed.
Swelling and bruising around the eyes are marked and expected. The flap and pedicle are checked often, and pain is generally moderate.
Sutures come out and swelling begins to fall. Life carries on with the pedicle in place, and most people prefer to stay close to home during this time.
The pedicle is divided at a second operation. Your nose looks bulky at first, and the brow area settles over the following weeks.
Shape, colour and thickness continue to improve. Minor contouring procedures are common and are planned once the tissue has softened.
Most patients finish with a nose that reads as normal from conversational distance, though close inspection shows the repair. Bulkiness early on is expected and improves with thinning procedures. Colour usually settles within a shade or two of the surrounding face. Sensation in the rebuilt part stays altered. More than two operations are often needed, and small differences between the nostrils are common.
This is a bigger undertaking than a local flap, and the risks reflect that. Most are manageable when picked up early.
Two sites need attention here. The forehead is the donor area and the nose is the recipient, and while the pedicle is in place it needs its own care.
A pedicled forehead flap needs at least two stages by design. Dividing the pedicle too early risks losing the whole reconstruction.
It is planned. That bridge is the lifeline of the flap and is removed only once the new tissue has grown its own blood supply.
Because it matches nasal skin in colour and thickness, it usually blends well after thinning and settling, better than skin borrowed from the arm or thigh.
Refinement is normal in nasal reconstruction. Thinning, adjusting the rim and evening out the nostrils are planned steps, not corrections of an error.
Nasal reconstruction at Elegance Clinic in Surat is planned as a series with a clear end point, and Dr. Ashutosh Shah walks patients through each stage, including how the face will look while the pedicle is still attached.
Technique pages do not carry their own price, since a forehead flap is a way of rebuilding rather than a treatment in itself. Cost depends on the condition being treated, the number of stages planned, any cartilage grafting, anaesthesia and the length of each stay.
Bands for the underlying treatments appear on their own pages, and a written estimate covering the whole staged plan is prepared after examination.
These are the questions that come up most often in consultation. If yours is not here, send it on WhatsApp and the team will reply, usually the same day.
Ask your question →No single price sits on a technique page. The figure depends on the treatment it belongs to, the number of stages, any cartilage grafting, anaesthesia and hospital stay. A written estimate covering every planned stage is given after examination.
It is a long established procedure with a dependable blood supply. Recognised risks include partial flap loss, infection, exposure of a cartilage graft and narrowing of the nostril. Stopping smoking well beforehand makes a real difference to healing.
The pedicle is usually divided about three weeks after the first operation, and light work is possible in between. Refinement procedures may follow over the next several months, so the full course often spans half a year.
Yes, the pedicle is visible between the two operations and most people find this the hardest part. It can be dressed discreetly, and it is removed at the second stage, leaving only a small area at the brow.
Small defects that a local flap can close do not need it. Irradiated or heavily scarred forehead skin, continued smoking, and being unable to attend for staged surgery all point towards a different plan.
Often at the same sitting, once the pathologist confirms clear margins. Where clearance is uncertain, the wound is dressed temporarily and rebuilding is planned for a later date, which does not harm the final result.
The defect is measured, the forehead is examined for scars and previous radiotherapy, and your health, medicines and smoking history are reviewed. Each stage is described with photographs so expectations are clear before booking.
Seeing patients from across the city and beyond: read about the practice on the plastic surgeon in Surat page, or check what a written estimate covers on the costs and insurance page.
