Paramedian Forehead Flap

Hi logie

Welcome to the skin cancer group.

I'm sorry no one has popped in to tell you about their forehead flap operation so I thought I'd tag a couple of people in the hope that they will see the post. Both  and  have posted of their experiences on here and hopefully they can tell you more about it.

In the meantime I would avoid googling as you always come across the worst case scenarios.Instead stick to sites like this one or Cancer Research UK if you want to find more information on BCCs. If you click on Understanding skin cancer at the bottom of my message this will take you to Macmillan's page.

Do you know when your operation will be?

x

Hi Logie

I had a forehead flap procedure in middle of forehead to remove my BBC 3 years ago. I was told it would be in the shape of a capital H so thought I'd look like Rimmer in Red Dwarf. In the end they did a flap that is 20mm down and 30mm across. It wasn't painful, they numbed the area and although I could feel prodding I felt no pain. Afterwards I had a mild headache but painkillers helped, I experienced swelling on the head and top of nose and eyelids but nothing major. I did have the numbness for a long time after  but feeling did eventually return. You will need a week off work to recover to rest it helped my recovery. The scar itself has settled down well, the only annoying bit is at the top of the incision going down, the skin gathered so I have a slight lump that annoys me, people say they don't notice it but because I know its there it sticks out more to me.

I haven't had any surgery on my nose so can't tell you about that but I can see lots of people on here have and can offer good advice. I'm going in again next Tuesday 20th to have another BBC removed from near my temple.  They're not sure if they will have enough skin movement to just stitch it up or if it's too large and needs a skin graft as quite close to eye now. I had this legion when I had last one removed but as if was slightly different to my head BBC(no  spot or indent just the pearly shimmy area) I mentioned it but didn't push for it to be checked out and consultant just said come back if grows. So bit of advice if you do have any other skin concerns get them checked properly. 

If your really worried about the op on the day talk to your surgeon and nurse, they will talk it through with you and try to ease your fears and reassure you.

Hope it all goes well, the unknown can be scary but it's never as bad as we think. Good luck xx

Hello Logie;

Firstly, I'm sorry you're going through this as I know it is very stressful (especially the waiting and uncertainty).  I have had two experiences with BCC on my face.  This past one was a very aggressive BCC that covered my nose and cheek.  After my Mohs surgery for the cancer I had a Paramedian Forehead Flap reconstruction (December 2017).   I am now three months into my recovery and let me assure you that you will be okay!  There are scars but they can be concealed and I have some great suggestions on how to do that (for down the road).  There are also some members here who have posted photos on their blog to show the progression after such a surgery - with amazing results.  The forehead flap reconstruction is the gold standard for nasal defects after BCC removal and it is an amazing procedure that is the best for a good cosmetic outcome.  

Having said that - it is a difficult procedure to go through emotionally and it feels like a long process (when you're in it).  It is important to have help and support for some time after the procedure (including being on this site!).  Also, it is a good idea to take as much time off of your work as possible (depends on your job of course.....for some jobs it may be easier to return earlier).  I took a full 6 weeks off (and really wished I had taken more as I work with the public in a very face-to-face and emotional job).  I think if I had had an office job I may have felt okay to return earlier. 

Typically the surgery is done in at least 2 stages - the first surgery involves moving a blood supply and skin from the forehead onto the nose.  This blood supply comes through the "pedicle" (joining the forehead and the flap of skin placed on the nose) and usually remains in place from 3 to 4 weeks).   The surgery is done under General Anesthetic and so you will not feel a thing.  After the surgery the pain (which feels like a headache on your forehead) is controlled by some good pain meds (which you will likely need for a few days).   For the days and weeks afterwards you will have to take care of the wounds and tend to them as advised by the surgeon (usually cleaning many times a day, followed by the application of ointment).  It feels odd to have a pedicle on one's face and so the weeks after I mostly stayed inside and wore a lot of bandages when I went out (I did not feel like being around people and took the time to catch up on my movie watching and music).  The second stage of the surgery (3-4 weeks later) involves the "division of the pedicle"  (i.e., removing the pedicle, touching up the nasal flap and lifting the eyebrow back into position if needed).  This second surgery is a great relief as it feels amazing to have the pedicle removed and you will look much more normal afterwards.  Some surgeons prefer a three stage procedure whereby the pedicle remains in place a bit longer and there is a surgery in-between to soften things up (I believe).  Mine was done in two stages - though I am having a third small elective surgery to tweak things a bit (6 months after the original surgery).   The second surgery is much easier and I had mine under local with twilight sedation.  After 2 weeks I was able to use make-up (invest in Estee Lauder double wear make-up.....it is amazing and I learned about it on this site) to cover the scars.   6 weeks after my second surgery I also went for Dermabrasion of the scars - which has been extremely helpful (though not necessary in all cases). 

When I was first diagnosed and the possibility of a forehead flap reconstruction was raised I was really scared and very upset (which I think is normal).  I only found out I actually had to have this the day before the reconstruction and so I wasn't really that prepared for it.  This site and the amazing members who had also gone through this were extremely helpful to me - I hope that I can offer you support and help as well.  No two situations are exactly the same but it sure helps to chat with others who are going through it or who have gone through something similar.  I do not live in the UK but from what I've been hearing on this site you are in excellent hands - you have a great medical system there. 

I hope I haven't overwhelmed you with too much information and please feel free to message me if you have specific questions. 

Warm wishes 

Penelope

Hello again Logie;

You may also be interested in checking on the "Recovery From Forehead Flap" message thread - there you will find a lot of the discussions between different members who have had this procedure and can find links to blogs about how it looks after (with great results!). 

Warmly

Penelope

Hi logie 

Sorry to hear that you have a bcc. I had a forehead flap done just over 2 years ago. 

In my experience although the operation looks horrific I personally didn't think it was that bad if I'm honest but I suppose everyone has a different experience and a different story to tell.

Pain wise it wasn't nothing that paracetamol and ibuprofen didn't deal with. My biggest moan was the cleaning regime 4 times a day and applying the antibiotic gel. Also not being completely comfortable in bed as having to sleep on my back.

I had 2 operations under General aneasthetic and a total of 8 weeks off work due to the fact I couldn't get my glasses on as my nose was slightly swollen and sore after they removed the pedicle. 

Like I said I'm over 2 years post surgery now and all is good. The scars are barely visible and I'm totally happy with the outcome. 

I've created a blog with pictures on my profile here if you want to check them out. Hopefully you can see my results and it will put your mind at ease a little. 

Good luck with your surgery and if there's anything you need to ask please don't hesitate to ask. 

Regards

Angie x

Hello. I’m new. BCC nose confirmed Feb. Saw plastic surgeon today. I Hoped for cheek flap but needs forehead flap. I thought I had prepared myself mentally for that one but find I am still very shocked and distressed. Normally very in control. Mohs and  reconstruction in 2 weeks.  Have been told 3 weeks off, am self employed. Also type 2 diabetic diagnosed almost 1 year ago. Any words of wisdom, also concerned  re my elderly father with Alzheimer’s likely reaction to my appearance. Also how can I find photos of  first few days post op, I would like to know how bad it will be. 

Hello Moomm;

I'm sorry about your diagnosis and the need for the forehead flap.  I am also sad to hear about your father (my mother had dementia many years ago and I know how difficult that is to go through with a a loved one).  

I'm presently in recovery from Mohs surgery, a forehead flap and a cheek flap reconstruction (back in December).  I truly believe the wait leading up to the surgery was especially stressful (with all the uncertainty and unknowns) whereas afterwards you go in "coping" mode and know the worst is over.  Though no two situations are alike (and you will find different experiences posted here), I can assure you it is very understandable and common to be distressed, shocked and scared.  And yes, it is especially hard when we are used to being in charge and in control - this is a real trial of emotional endurance. All this to say, though it is difficult to go through -the end result is always very positive!  I do think it is good to prepare yourself for the experience of seeing yourself after the surgery (which can look pretty gruesome truthfully).  I've explained a bit about the surgery above in another reply and some other members here have posted photos (I was thinking posting some but mine was a particularly extensive procedure and I don't want to scare people).   In terms of your father's reaction, I think it is a valid concern and I suggest you do not have him see you without your bandages.  There are ways to cover the pedicle and the incisions with bandages (I did this whenever I was in public or with friends in between the first and the second surgeries).  

I am also self-employed and work in an area that is quite emotionally complex and involves seeing people in close proximity.  I originally took 4 weeks off but then had to extend this to 6 weeks (as I my pedicle had to remain in place for 4 weeks).  I was able to do some of my work via the internet and telephone while I was away however (maybe you can do the same?).  In terms of diabetes, I am not sure how that may impact your recovery except that i imagine you will have to be particularly attentive to your sugar levels (as stress and healing likely affect that) - good to check with you diabetic doctor of course.  Unless yours is a very small BCC, I suggest you prepare to be able to take more that 3 weeks off work if at all possible.  The impact of the general anesthetic alone and the energy the body seems to take in the healing process can really "take it out of you".  I am an extremely athletic person and I was totally wiped out physically for at least a full two weeks after the first surgery and it took quite a while for me to return to my usual energy levels.  Again, this is based on my experience and you will likely and hopefully have an easier time of it (my cancer covered the majority of my nose, some of my cheek and a piece extremely close to my eye as well).   If you have any other questions, I would be happy to answer as best I can. 

I wish you all the best and please keep us posted on how you're doing. Warm wishes, Penelope 

I won’t repeat all that has already been stated, but will offer this. It’s not near as painful as it looks!!  The worst part for me was the numbing before Mohs, (but that was only about a mnute) and the tiredness from general anesthesia after theflap surgeries.   But here are some tips to help.  Use ice the day and evening after surgery. It held with swelling and bruising. Take your pain meds as stated in your prescription even if you don’t feel like you need it. That helps you “stay ahead” of any pain. I took Hydrocodone for 3 days then switched to extra strength tylenol which worked fine. Sleep upright for a few nights to minimize swelling. I used a neck pillow like you take on a plane. Rest, rest, rest!  And a couple of other tips- have lots of qtips on hand.  Unfortunately the flap oozed especially overnight, so it helped to clean around my nose. And to scratch under the bandage if needed!  Prepare for no glasses!  I got a lighted magnifying glass so I could read. Plan to take off from work as long as you possible can. My complete procedure was 6 weeks from Mohs until final stitches were out. If that’s not possible you can cover the flap and forehead incision with a gauze bandage and surgical tape. I was lucky not to have to go to work, but I did cover it the few times I went out. And just keep thinking MY CANCER IS GONE! Best of luck. 

Thank you so much. It is very comforting to hear other people’s experiences. I also lost my Mum to dementia a couple of years ago. I am interested to hear more about the bandage idea. My plastic surgeon says he prefers to leave as much uncovered as possible but we will see I am sure!

Thank you so much , it is a great comfort to hear how others have coped. Has anyone else had to shave the hair on the end of their nose flap ?. I have been promised this particular joy to come