Expertise: Reconstructive surgery

A real case study in the power of collaboration 🙏👨‍⚕️⬇️

This patient had a biopsy-confirmed basal cell carcinoma, also known as a BCC, on the right nasal ala – the outer part of the nostril 👃

On the surface, it looked subtle and was very difficult to define. It had first presented as a “pimple” that started to bleed, would not heal and reopened with the slightest knock.

Biopsy confirmed an infiltrative subtype of BCC, which can extend beyond what is visible to the naked eye.

Dr Sajjad Rajpar performed Mohs surgery, carefully removing the BCC in layers to ensure accurate clearance while preserving as much healthy tissue as possible 👨‍⚕️🥼🔬

Once the cancer had been fully removed, Mr Ross Elledge carried out a staged reconstruction using a paramedian forehead flap 🪡👨‍⚕️👃

This is a complex reconstructive technique where vascularised skin is raised from the forehead, based on a robust blood supply from an artery just above the eyebrow, and rotated down to reconstruct the nose.

The flap then remained connected to the forehead for several weeks while it developed a new blood supply on the nose, before being divided and shaped during a second-stage surgery to restore form and function.

Paramedian forehead flap reconstruction is an extraordinary technique with a remarkable history. Nasal reconstruction using local tissue has roots in ancient Indian surgical practice, and the forehead flap later became a preferred method for nasal reconstruction due to its reliable blood supply and flexibility 🙏

➡️ Beyond the surgery itself, cases like this are about the full patient journey.

✅ Timely diagnosis.
✅ Specialist Mohs surgery.
✅ Aesthetic reconstruction.
✅ Close support through multiple surgical stages.

And collaboration between clinicians with the same goal: the best possible outcome for the patient 👏👏👏

➡️ Clear from cancer.
➡️ Beautifully healed.
➡️ Almost imperceptible.

A fantastic result – and a privilege to be part of this patient’s care 🙏👃