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Upper Facial Reconstruction


Clinical Presentation

A 52-year-old White male had a “large” melanoma in the right temporal area ( Fig. 2.1 ) and underwent a wide local excision of the temporal melanoma with a 2-cm margin and sentinel lymph node biopsy in the face and neck by the surgical oncology service. He had a 4.5 × 4.5 cm skin defect down to the superficial temporal fascia involving the upper face, temporal area, and cheek ( Fig. 2.2 ). The plastic surgery service was asked to close this large skin defect after the wide local excision and sentinel lymph node biopsy.

Fig. 2.1, A preoperative view showing a melanoma in the temporal and upper facial regions and an outline of potential margin for the wide local excision.

Fig. 2.2, An intraoperative view showing a large skin defect involving the temporal, upper facial regions and cheek as well as incisions for cervical lymph node dissection in the face and neck.

Operative Plan and Special Considerations

Based on the size and location of the skin defect and the existing incision for sentinel lymph node biopsy in the face and neck, and skin laxity in his neck, a large cervicofacial flap was designed for this patient. The procedure itself would be similar to a classic skin-only face lift performed by plastic surgeons for facial rejuvenation. In this procedure, the excess lower face and neck skin could be dissected free and used to reconstruct the large skin defect in the upper face and temporal area. Therefore, the defect could be closed primarily and no skin graft would be needed.

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