Facial Reconstruction After Mohs Surgery | Skinner Dermatology

The face presents unique challenges and unique opportunities in reconstruction. Its rich blood supply, the abundance of adjacent tissue with excellent color and texture match, and the framework of natural lines and creases all work in the surgeon's favor. But the face is also the area patients care about most — and where surgical outcomes are most visible.

Dr. Skinner's approach to facial reconstruction is guided by a meticulous understanding of facial anatomy, a deep familiarity with the available reconstructive options, and a commitment to results that look natural.

Cheek Reconstruction

The cheek is a large, relatively flat surface with good tissue laxity — particularly in older patients. Cheek defects are often amenable to side-to-side (primary) closure when small, and to rotation or advancement flaps for larger wounds.

Cervicofacial Rotation Flap

One of the most versatile flaps for large cheek defects. A large arc of cheek and neck skin is elevated and rotated upward to fill the defect. The donor scar is hidden along the preauricular crease, the hairline, and the neck — areas where scars are well-concealed.

Subcutaneous Pedicle (Island) Flap

An island of skin is mobilized on its underlying fat and blood supply and advanced or transposed to fill the defect. The skin overlying the pedicle is left in place, with only an internal movement of the island — producing a single-stage closure with minimal visible scarring.

Forehead & Scalp Reconstruction

The scalp and forehead have unique tissue properties — the scalp in particular has limited elasticity due to its galea (the fibrous layer beneath the skin). Large scalp defects may require creative solutions.

Rotation Flap

Using the curved geometry of the scalp, rotation flaps redistribute tissue from a wide arc to close smaller defects. Multiple opposing rotation flaps (O-to-Z, pinwheel designs) can address larger wounds.

Skin Grafts for Scalp

Split-thickness skin grafts are appropriate for large scalp wounds where a flap would place excessive tension. They are particularly useful on the vertex where functional outcomes (protecting the skull) take priority.

Eyelid & Periocular Reconstruction

The eyelids are among the most functionally demanding areas of the face to reconstruct. Improper closure can cause ectropion (outward turning of the lid), lagophthalmos (inability to fully close the eye), or epiphora (excessive tearing) — all of which can threaten long-term eye health.

In-Office Periocular Reconstruction

Dr. Skinner performs reconstruction for smaller periocular defects where primary closure or a limited local flap is appropriate.

Oculoplastic Co-Management

For defects involving a significant portion of the eyelid margin, full-thickness eyelid involvement, or any case where function may be at risk, a consultation is scheduled to carefully evaluate the defect. Many of these cases are co-managed with or referred to an oculoplastic surgeon to ensure the best possible functional and cosmetic outcome. Dr. Skinner will tell you clearly which applies to your situation.

Lip Reconstruction

The lips are complex functional structures with a defined aesthetic border (the vermilion border) that must be respected in reconstruction. Even minor misalignment of the vermilion is noticeable.

Upper Lip

Small defects can be closed directly along the philtrum columns (the vertical ridges above the lip) or along the vermilion border. Larger defects may use Abbe flaps (transferring a segment of lower lip) or nasolabial transposition flaps for lateral defects.

Lower Lip

Lower lip defects involving up to one-third of the lip width can generally be closed primarily. Larger defects may require Bernard-Webster flaps or Karapandzic rotation flaps — techniques that maintain the oral commissure and orbicularis muscle function.

Complex Cases Welcome

Patients are sometimes referred to academic centers for complex facial reconstruction — but the same training and skill is available right here in Alcoa. Dr. Skinner's fellowship in cutaneous oncology and reconstructive surgery, combined with over a decade of high-volume surgical experience in East Tennessee, means complex cases are part of our everyday practice.

(865) 268-4444