NASAL RECONSTRUCTION

The nose is the central feature of the face. Yet when in harmony with remainder of the face, the nose is hardly noticed and attention is focused on the beauty of the eyes. But an unfavorably shaped nosedraws immediate attention to itself, and the face may appear displeasing. Just as important, the nose is essential for breathing and our sense of smell. The goals of nasal reconstruction are to reestablish balance of the nose with rest of the face and to restore nasal function. The nose may be reconstructed by simply bringing the wound edges together, but larger wounds may require recruiting tissue from other parts of the nose, cheek or forehead for adequate repair. Dr. Bhrany chooses a method that results in the best cosmetic and functional outcome in the safest possible way for our patients.

What is Involved with Nasal Reconstruction?
The Initial Consultation

Nasal reconstruction is typically performed to repair a wound after the removal of a nasal skin cancer. Skin cancer is the most common cancer in humans, affecting 1 in 5 Americans over their lifetime, and over 1,000,000 in new cases are diagnosed in the US annually, with the state of Washington among the highest rates. Basal cell cancer is the most common skin cancer followed by squamous cell cancer, and then melanoma. Thankfully, due to slow growth and early detection, dying from skin cancer is very rare.



Since Dr. Bhrany specializes in the treatment and reconstruction of facial skin cancers, you may be referred to him by your primary care physician for evaluation of a skin lesion (bump or ulcer) suspicious for a skin cancer. If you have already been diagnosed with a nasal skin cancer, you may be referred to Dr. Bhrany by a dermatologist who specializes in Mohs skin cancer surgery (see more below) to discuss repair of the subsequent wound after your Mohs surgery. If you are referred Dr. Bhrany with a suspicious lesion, he may perform a biopsy in the office to identify a potential skin cancer.  If the biopsy confirms a skin cancer, possible treatment options will be discussed. Mohs skin cancer surgery is most commonly recommended.

 

Examples of Nasal Skin Cancers


Mohs skin cancer surgery is a technique to remove skin cancer that is especially useful for treating skin cancers of the face. Mohs surgery has the highest cure rate while maximizing the amount of normal tissue spared during removal. In other words, Mohs surgery often provides the highest chance you will remain cancer free while achieving the best cosmetic outcome. Typically, the Mohs dermatologist will remove the skin cancer in his or her office, and then you will have your reconstruction either later that day or the next day with Dr. Bhrany. Dr. Bhrany works very closely with a number of Mohs dermatologists in the Seattle area (Mohs Dermatologists) and can guide you through the process of your skin cancer treatment. Depending on the size and location of your skin cancer, there are instances when Dr. Bhrany will both remove the skin cancer (called a wide local excision) and reconstruct the subsequent defect at the same setting without Mohs surgery.



During your consultation, a variety of techniques for nasal reconstruction are discussed. A method is chosen that results in the best cosmetic and functional outcome for you (Learn About Nasal Reconstruction) The details of the procedure and post-operative care are explained, and any questions you may have are answered. Once the plan is confirmed, you meet with Dr. Bhrany’s patient care coordinator to schedule a surgery date.





Pre-operative Visit

For patients requiring either moderate sedation or general anesthesia for your procedure, you may be asked to come in for a pre-operative visit prior to your surgery. This visit typically involves a pre-operative history and physical at Dr. Bhrany’s office with his physician assistant or nurse practitioner and a meeting with our anesthesiologists. This visit is performed to assess any medical issues you may have and to ensure that your surgery is conducted in the safest manner. Pre and post-operative instructions are reviewed, and this visit is also an opportunity for you to ask additional questions that may have arisen after your initial consultation.



Day of Surgery

If you undergo your Mohs surgery the day before reconstructive surgery with Dr. Bhrany, you will arrive to the operating room typically 90 minutes before your scheduled surgery start time (which is provided by a phone call the night before). If you are having your Mohs surgery on the same day as your reconstructive surgery, you will come to the operating room directly from your Mohs surgeon’s office after he or she has completed the skin cancer removal.


Once in the pre-operative area, you will meet the nursing and anesthesiology staff who will take care of you during your procedure. Dr. Bhrany will meet with you and your family prior to the procedure to review the procedure and discuss any last minute questions you have. After the procedure is performed, you you will be taken to the recovery room. You will have a bandage in place that typically you will remove the next day at home sincemost nasal reconstructions are performed as outpatient surgery. You will be sent home with detailed post-operative instructions and pain medication. Dr. Bhrany will call you on the night of surgery to ensure that you are doing well and to answer any questions you may have. Some larger reconstructions may require an overnight stay in the hospital. In that instance, he and his team will see you the next morning to remove your bandage and discharge you home.



Post-operative Visits and Follow-up Care

Your first post-operative visit will be approximately one week after surgery to remove your sutures and to monitor your healing.You will then follow-up at one month after surgery and then every three months for the first year after your surgery to ensure adequate healing. For nasal reconstructions that require two-stages, you will be scheduled for the second stage approximately 3 to 4 weeks after your initial surgery (Learn About Nasal Reconstruction ).


Examples of Nasal Reconstruction One Week After Surgery