In short. When a smaller flap is enough: bilobed, dorsal nasal, nasolabial and cheek advancement flaps, and the nasal defects each one suits.
Key points
- Location decides more than size.
- A defect of the alar rim needs tissue that can fold and hold the airway open, which favours a nasolabial or a composite flap.
- A defect of the tip needs convexity, which a bilobed flap supplies.
Not every nasal defect needs a forehead flap. Many are small enough that skin can be borrowed from the nose itself or from the crease beside it, closed in a single operation, with no temporary pedicle and no second stage. The trade is that the flap must fit the defect almost exactly, so the choice is narrow and the assessment matters more, not less.
Where the tissue comes from
Local flaps take skin immediately next to the defect and move it in, keeping its blood supply attached. Because that skin comes from the same aesthetic unit, colour and texture match are usually very good, better than a graft achieves. The price is the extra scar left where the skin was lifted, which is why the incisions are designed to fall into natural creases and subunit boundaries wherever possible.
The common types
A bilobed flap borrows two lobes of skin from the upper nose and rotates them down, closing the secondary defect where the skin is looser. It suits small defects of the tip and ala, around a centimetre across. A dorsal nasal flap advances skin from the bridge down over the tip on a single pivot. A nasolabial flap brings skin from the fold between cheek and upper lip up to the ala, and is especially useful for alar defects because that fold hides the scar. A cheek advancement flap moves the whole cheek upward and inward to close defects of the sidewall and alar base.
The right flap depends on where the defect is
Location decides more than size. A defect of the alar rim needs tissue that can fold and hold the airway open, which favours a nasolabial or a composite flap. A defect of the tip needs convexity, which a bilobed flap supplies. A defect of the sidewall has looser surroundings and tolerates advancement. The commonest reason a local flap disappoints is not technique but choosing it for a defect that needed lining or support as well as cover.
Who suits a local flap
The best candidates have a small defect, healthy surrounding skin with enough laxity, and no history of radiotherapy or heavy smoking in the area, both of which compromise the blood supply a flap depends on. Previous nasal surgery is assessed carefully, because earlier incisions alter which vessels remain reliable.
Recovery and honest limits
Local flaps are usually single-stage, with sutures out in five to ten days. Swelling and bruising settle over two to three weeks and the flap softens over several months. There is a small risk of partial flap loss, particularly at the flap tip, and of a trapdoor contour that may soften with time or need a small revision. Colour match is good, but the flap usually stays slightly paler or pinker than the surrounding skin. Final assessment is at six to twelve months.
Seek review if
- The flap edge becomes purple, black or cold, or the skin over it develops a mottled, blistered look.
- Pain or swelling increases sharply after the first few days rather than settling.
- The scar thickens, itches or spreads beyond the incision in the months after healing.
Frequently asked questions
When is a local flap enough to close a nasal defect?
When the defect is small, the surrounding skin is healthy and has enough laxity, and there is no history of radiotherapy or heavy smoking in the area. Local flaps are usually single-stage, so there is no temporary pedicle and no second operation, but the flap must fit the defect almost exactly.
What is a nasolabial flap used for?
It brings skin from the fold between cheek and upper lip up to the ala, and is especially useful for alar defects because that fold hides the scar. A bilobed flap suits small defects of the tip, and a cheek advancement flap closes defects of the sidewall and alar base.
What are the limits of a local nasal flap?
There is a small risk of partial flap loss, particularly at the tip, and of a trapdoor contour that may soften with time or need a small revision. Colour match is good, but the flap usually stays slightly paler or pinker than surrounding skin. Choosing one for a defect needing lining or support is the commonest disappointment.
Risks & Limitations
- Nasal reconstruction is usually staged — two to four operations over months is normal, and the plan may change as healing progresses.
- A forehead flap leaves a permanent donor-site scar on the forehead and a temporary pedicle that looks unusual while it heals.
- Matching the colour and texture of facial skin is imperfect; a graft or flap usually stays slightly paler or thicker than the nose around it.
- Partial or complete failure of a graft or flap, which may require further surgery and a new plan.
- Narrowing of the airway, which can develop months or years later as scar contracts.
- Further revision is often needed to refine contour, thin a flap or release a narrowed airway.
- Altered or reduced sensation in the nose and, after a forehead flap, in the forehead.
- Final assessment is made at 6–12 months, never at the first dressing change.
When to Seek Care
- A flap or graft that turns dark, cold or black, or a wound that opens and does not close.
- Fever above 38 °C, or spreading redness, warmth or discharge around a wound.
- Difficulty breathing through the nose that worsens rather than settles.
- Bleeding that does not stop with gentle pressure.
- Severe pain, or a tense swelling under a flap or around the reconstruction.
References & Further Reading
- American Society of Plastic Surgeons (ASPS) — reconstructive surgery guidance
- Cochrane Library — systematic reviews in wound and reconstructive care
- Chinese Medical Association, Plastic Surgery Branch — clinical guidance
- World Health Organization (WHO) — surgical safety and emergency care resources
This page is patient education, not medical advice, and it does not cite individual studies. Discuss your own case with a qualified clinician. To arrange an assessment at Chongqing West District Hospital, see Contact & Consultation.