Recovery from forehead flap nose reconstruction

Hello Bev

So sorry to hear what you are going through.  My journey has been ongoing since January this year and, like you, the biggest issue for me has been dealing with it emotionally and mentally.  Also, other people and them thinking it is fine to comment on how I look has affected me big time.

I think it is important to listen to your body and go with you feel, which will probably change daily.  My world has closed in and become smaller since the beginning of my treatment, and I have just spent time with the people closest to me.  I have continued going to the gym but have just done yoga, a class/sport where I haven't had to mix with anyone.  I have also enjoyed spending time at home, which is a rare treat!  As well as all of that, I think it is important to try and keep busy and occupied.  It has been so hard facing the day and going to work every day, looking the way I do (I've a left cheek which is red, sore, swollen, scabby and weeping at times!) but it has been a godsend being busy, occupied and distracted.

Thinking of you.

Rebecca x

I've been following everyone's stories carefully as I'm booked in to have Mohs surgery for a bcc on the tip of my nose in late November. It's an infiltrative bcc & quite large as the dermatologist was treating it as a sun spot for 2 years. After I met with the Mohs surgeon he sent me to the plastic surgeon for a consultation & it seems certain that I will be having a forehead flap. This means that I'll have the revision surgery just before Christmas. I wonder if anyone can tell me how long it takes in weeks or months to feel confident appearing in public after the revision surgery. I am going to a wedding at the end of March which will be 3 months after the revision. How noticeable will the graft be at that time? I know everyone heals differently & the skill of the plastic surgeon is also important but I can't find any definitive information about how it might look after 3 months. I'm dreading the whole experience but also realise just how lucky I am that it's not a melanoma & that I live in a country with good healthcare. The two month wait for surgery is stressful but it's giving me time to get things in order and find out as much as I possibly can.

Many thanks in advance for answers to my queries.

Best wishes,

Emily

Hi Emily. 

You should be more than ready for the wedding in March.

I had my Mohs surgery in early July, and had a dressing on my nose. I did go out, but only if really necessary. I had the forehead flap done about 5 days later. Then I had a bulky dressing over my nose and my forehead. I went to my dr every two to three days for them to check things out and to change the dressings and clean the wounds.  The only place I went during this time was the dr’s office.

The flap was “taken down” (disconnected) after about three weeks, so maybe the 2nd or 3rd week in August. Stitches came out from my forehead after a week. I wore a dressing or large bandaid over the forehead area but It was mostly to keep my grandkids from going “ewww.” I wore a dressing over my nose until the stitches came out, which was just a few days after the forehead stitches were removed. Once I was down to just bandaids, I felt ok going out in public and being around my grandkids.

I’m sorry you have to go through this. it’s no fun, but you have the right attitude - and the cancer will be gone! I will add that I had minimal pain during this time. The worst sensation was itching. And boredom was a problem for me. You’ll be fine and back to normal before you know it. 

I am retired, so I didn’t have to worry about going to work. 

Oh, My dr did a laser treatment on my nose two weeks ago to smooth out any bumps or scars, I wore a loose bandaid over my nose until the scabs came off, about 5-6 days. Now it’s just a little pink, but overall, it’s looking great. 

Bev

Hi Emily 

Sorry that you have to go through this. I'm almost 3 years post surgery now and you can hardly tell I've had anything done.

It takes a few months for everything to settle down after the separation I must admit but each day shows an improvement. I would say that the scars will still show a bit of redness after 3 months and maybe not be as flat as you'd like them but hey you've undergone a major facial surgery so own them.

The only good advice I can give is keep a vigorous cleaning routine 3 or 4 times a day and apply the gel they give you. I got some saline from the chemist and used cotton wool and q tips to clean. After I had the 2nd lot of stitches removed I used the gel for another 7 days then normal vaseline for a few more weeks. 

I also never left the house during the first stage only for my hospital appointments as I didn't want the open flesh to get infected. 

I have posted a few pics of my process on my blog if you want to look at the different stages.

Feel free to ask any questions and I hope everything goes well for you. I know it's a daunting experience at the time but I can promise you the results will be good.

Regards 

Angie

Thank you Bev & Angie. I feel less anxious knowing that you have both been through this and have come out the other end feeling ok about it. Thanks for sharing your experiences & I will look at the photos on your blog Angie.

Bev, I was wondering if you are able to use any foundation or make-up to cover the area where you've had the graft. When I go to the wedding at the 3 month period I was hoping that the graft would be healed enough for me to be able to disguise it a little.

I am retired as well so having to go to work isn't an issue but not being able to wear glasses will be a challenge as I love to read and will miss that terribly. My wonderful optometrist has lent me a magnifying lens that I can hold to one eye to read texts on my phone etc. I only wear glasses for reading but will find subtitles & general computer work quite difficult. I'm sure that boredom will also be a challenge as things like gardening & even cooking may be a problem for a while. This is my second bcc & I'm sure it won't be my last experience but hopefully it will be found sooner. My first was on my cheek near my nose & was nodular. The dermatologist used a cream & photodynamic therapy to remove it about 2 years ago. It was about 1mm deep, very different to this new infiltrative one.

The scariest thing is having to wait so long for the Mohs surgery & then not knowing how many 'goes' it will take to remove it all.

Thank you both.

Regards, Emily 

This is me 3 months after the 2nd stage of my forehead flap surgery ( no makeup in this picture).   I was able to wear makeup just 2 weeks after the final stitches came out.  The Mohs surgery was not as difficult as I had feared.  The only hard part was numbing but that was over rather quickly. I had 2 “goes” and the Dr did do some additional numbing but I didn’t feel it  Glasses were also an issue for me.  I did audio books and a lot of Netflix!  I also got a magifying glass used for crafting and was able to read with that.  As for the flap surgery, be sure you take pain meds as prescribed to stay ahead of the pain.  I only needed prescription meds for 3 days, then I switched to Tylenol for about 3 days, and that’s all I needed.  The pain was surprisingly minimal. Q-tips are handy for the itching, and sleeping upright for several nights will help prevent swelling.  I used a neck pillow like you would take on an airplane. Also, ice -especially the first hours after surgery- can help reduce bruising. I bruise easily, so I had a lot of not so pretty colors, but they were gone within 2 weeks.  I know it all sounds overwhelming, but the results will be worth it all. No cancer!  Best of luck for an uneventful recovery!                              

Hi melm68 thank you so very much for posting your photo. You're looking fantastic and it makes me feel so much more positive seeing this and hearing about your experience.

I was dreading having everyone staring at my nose (not my favourite feature & less so now!) but I really don't think anyone would notice yours.

I'm hoping I can share my experience once it's over to assist others in the same way you have.

Take care,

Emily

Ok guys and girls. Seems no posts since October 2018, so I'll offer something as a new member as I appreciate everything that I've read so far.

I'm a generally very fit, active and healthy 66 year old man in UK. I had a keratoacanthoma growth excised from the right side of my nose about 8 weeks ago and had a skin graft over the area taken from my shoulder. It started to heal well. Unfortunately when the histology on the scrapings etc around the margins of the excision were received by the surgeon 4 weeks later it showed Squamous Cell Cancer present in the nose.

A further very large SCC growth came up within 2 weeks in the same nose area, nearly bursting the new skin graft it swelled so much and the only practical solution was removal of virtually the entire right half of my nose.The surgeon arranged it pretty promptly. I had the forehead flap procedure under general anaesthetic 6 days ago. It's a pretty large one and I have more than 70 stitches. It took about 5 hours to complete and like many others have found the anaesthetic after effects were probably the most unpleasant part of the first few recovery days.

I only spent one night in hospital and have been home since then with nose/pedicle and forehead under fairly large dressings. I reattended hospital 3 days after the surgery for dressing changes and will reattend again in 2 days from now (ie 7 days after the surgery) for an inspection and another full dressings change.

Like many others on here I have had quite a bit of oozing/leakage but part of that is down to me having been on an anti-coagulant (clopidogrel) for several years. So far, also like some others the pain is bearable without resorting to anything more than paracetamol and ibuprofen.

I am blessed to have a wonderfully supportive partner (wife). So far have no idea what the schedule is going to be for the next stages (separation etc) but am hoping it won't drag out too long. I need to get back on the golf course as have a Club Championship to defend lol. The dog senses something isn't right too and seems keen to try to 'help'.....but obviously I have to stop all his attempts to 'help' by licking the wound areas, infection risks being what they are. I could be kidding myself a bit re what is motivating his concern as apparently the dressings clinic have used Manuka Honey between the dressings and the wound lol. 

I'll post up about progress in due course in case any of my experiences are useful to other newbies worrying about the whys and wherefores.

Hi Mike. Sorry you’re having to go through this, but you’ll come out the other side better than you expect. 

I was surprised at your mention of Manuka honey used on your wounds. I’ve heard of it but never used it. Funny that your dog smells it and tries to get some.

My surgeon said to only use Vaseline on the wounds - readily available and cheap. He had me go to his office every couple of days for dressing changes and to be sure it was healing properly. I did buy several different sizes of bandaids to use after the pedicle was removed. I didn’t HAVE to use them, but did for the benefit of my kids and grands. I’d guess it was about three weeks after pedicle removal before I felt comfortable enough to go out without bandaids, or to let my grands see it.

I had lots of ineffective shots of local anesthetic for the Moh’s surgery (5 times he came back in and said, “I just need a little more.”), don’t know why it was ineffective but it was awful, and the surgeon said he’d prefer to use a general anesthetic for the reconstruction as well as for removal of the pedicle. That was fine with me, and I had no problems afterwards. It was all done in an out-patient surgery center, no overnight stays.

I have since had a laser treatment done to smooth out some areas on my nose, which was helpful. That took about a week to heal, and afterwards, nobody could even tell I’d had all these procedures done (except me). 

I also have several tiny blond hairs on the tip of my nose, which is kind of comical if you think about it, being from the hairline. But nobody else can see them. I pluck them when I see them. 

Wishing you the best outcome. 

Bev

Thanks Bev for the thoughtful and positive vibes. Now 7 days since the procedure. Was back to hospital today for dressing changes. They've abandoned the Manuka Honey tactic, partly due to it contributing to making dressing removal/changes difficult and painful due to the oozing honey mixing with the significant amount of blood I still secrete thanks to my anti-coagulant.....and then hardening on the dressings. They've switched and gone to petroleum gel between the dressings and wounds. They say the pedicle appears healthy and thriving in position though despite some ongoing bleeding.

I know what you mean about ineffective locals. The first nose growth I had removed and skin-grafted several weeks ago was done under local and I could feel just about every excision cut and graft stitch despite at least 8 doses of the stuff one after the other. There was never any question of the much larger removal of basically the entire right half on my nose being done in any way other than under general and the related pedicle removal etc will be likewise in a few weeks time.

Glad you found a way to spare your grands etc from any frightening views. Pretty sure I'll follow that tip when the time comes.....right now it's still all swathed in dressings and invisible anyway.

All the best. Mike

PS...….the dog still makes straight for my face and examines it intently real close up before then settling down far closer to me than normal, ensuring he's tight up against my torso or thighs wherever I'm sitting. Won't let me out of his sight either. My wife reckons he intuitively knows I'm ill and is being protective so maybe it wasn't all about the honey smell lol.