Face Gallery

A woman in her late 60s with drooping of her earlobes and a partial split.  She did sleep with her earrings in. She has been shown before and again, 3 months after the repair.

A woman of color in her late 20s who had gauges in her ears starting in middle school, and no longer likes the look.  She also has second piercings that have become irritated, most likely from a nickel allergy.  She is shown before and again, 6 weeks after bilateral gauges repair with a z-plasty.  At 6 weeks, the scars are at their thickest and reddest.  We will start her now on topical silicone.  Scars typically will fade and improve over the next 2 years or longer.  It will be important for her to protect her earlobes from sun exposure to decrease the risk of scars darkening.  This is called  “post-inflammatory hyperpigmentation” or “PIH” and is more common in patients who tan easily.

A woman in her mid-70s with biopsy-positive skin cancers on her left ala.  Her case is complicated by having been a smoker until the age of 60.  She has COPD and has home oxygen. She has had nasal basal cell carcinomas excised in the past.

Immediately after Mohs surgery by Dr. Grande, she had a large defect, which included part of the nasal lining.  A nasolabial angular artery flap does not always work in a prior smoker, but it seemed preferable to a forehead flap given her health issues. A lining flap was performed in the first stage, along with an ear cartilage graft and a nasolabial angular artery flap.  We returned 4 weeks later to divide and inset the flap.  At 6 months, we returned for a small third stage to better contour the flap.  She is shown 6 months after this final contouring procedure.  A relatively  normal contour and appearance have been restored to her nose after the three stages

A woman in her mid-70s with 2 defects after Mohs surgery for basal cell carcinoma, one at the base of her ala, and one on her medial cheek.  It is best to address these as 2 separate aesthetic units, as we view faces in patterns.  If these were repaired with one graft of one flap, it would not fool the eye.  She would not pass  “ the little girl test”.

I repaired the cheek defect along the nasolabial crease, where the eye expects to see a line.  Using some of the skin and fat that would have been discarded, I placed a skin-fat composite graft to the defect on the ala.  At 4 months, it is difficult to notice, even from a close distance.  The discerning eye will notice that on the surgical side, the nasolabial crease looks more youthful than on the non-surgical side, but this does not stand out.  A nice reconstruction, treating the areas a 2 separate aesthetic defects.

A woman in her late 70s with squamous cell carcinoma in situ of her upper lip.  She is shown at the time of presentation to her dermatologist,  immediately after Mohs excision by Dr. Grande, and 4 months after our reconstruction with a “lip lift” and recreation of the normal upper lip shape, called a “cupid’s bow.”

A man in his mid-70s with melanoma in situ/ lentigo maligna of his left nose.  He is shown before, just after his last stage of modified Mohs performed by Dr. Grande with a 1.5 cm defect, 6 days after composite skin fat graft.  6 weeks after repair and again at 3 months.

Discussion: With a typical full-thickness skin graft, the fat is removed, and it works well on the upper nose, but does not match in color and texture on the lower nose.  With a composite skin/fat graft, the fat is left on.  The graft typically looks like it is not working, with the top becoming a scab. Still, the deep layers take, and the scab typically falls off at 8 weeks or so, allowing a good result with a less complicated procedure than a local or distant flap.

A woman in her mid-20s with a partial split of both ears, right more than left.  She has slept with her earrings in, and on discussion, most likely has a nickel allergy as well.  She is shown before and again, 3 months after repair, in the office under local anesthesia.

She will be re-pierced with titanium earrings and will avoid sleeping with her earrings in place, and will avoid exposure to stainless steel in the future to decrease her risk of splitting again.

An Indian woman in her late 50s, who had her ears repaired in India 6 months before but did not like the appearance and felt that her ears looked “droopy.”  On measurements, her earlobes are 10 mm on her right and 11 mm on her left.  She is shown at our visit and again, 5 ½ months after the bilateral earlobe lift.  The earlobes have a more youthful contour and the splits have been repaired. Discussion: An attractive ear is a youthful ear in studies, with the most attractive attached to free border length being 5 mm or less when evaluated by multiple independent observers.

A woman in her later 60s with a basal cell carcinoma of her nasal tip. Her first photo shows the basal cell carcinoma.  The second view is immediately after resection by her Mohs surgeon. The third view is 6 days after a Bilobed flap repair. The last photo is at 9 months.

Discussion: The Bilobed flap repair transfers tissue from the horizontal aspect of the nose where we have some excess, by using two flaps. It initially looks like a letter B. As the scars fade and improve with time, the tissue texture and quality blend into the tip. It is often said to give the best final result in defects of the nasal tip that are 1.5 cm or smaller. She passes “the little girl test.” She does not look deformed and the appearance of her nose is not commented upon by young girls and young boys.

A woman in her late 20s with a partial split of her right earlobe since college. She did sleep with earrings in place. She is shown before and again, 4 months after repair in the office. She has been using the topical silicone that we recommended and her scars have faded nicely. She will re-pierce with titanium earrings to decrease the risk of a nickel allergy.