Loading
Procedure guide · Reconstructive Plastic Surgery
Facial ReconstructionFacial reconstruction rebuilds the face after cancer surgery, injury or a condition present at birth. Function comes before appearance: an eyelid that closes, a mouth that seals and a nose that breathes matter more than symmetry. Surgeons plan by aesthetic subunits, replacing a whole unit rather than patching part of one, and use the simplest method that will reliably close the defect.
Facial reconstruction rebuilds the face after cancer surgery, injury, burns or a congenital condition. It is the part of plastic surgery where the techniques are most refined and the constraints most severe, because the face is both functionally dense and permanently visible. Everything here is a compromise between what needs to work, what can be spared and where a scar can be hidden.
The ordering of priorities is the first thing to understand, because it explains results that otherwise look like poor compromises. Function comes first, and the reasons are not aesthetic. An eyelid that cannot close fully leaves the cornea exposed, which causes damage and can cost sight. A mouth that cannot seal causes drooling and impairs speech and eating. A nose that cannot breathe affects sleep and exercise. Where any of those competes with symmetry, symmetry loses. A surgeon who explains this early is preparing a patient for a result they will otherwise find puzzling.
The second principle is aesthetic subunits. The face divides into regions the eye reads as single wholes: the nasal tip, each nostril, the upper lip, a cheek, the chin. A scar falling on the border between two subunits, where a natural shadow already sits, is barely noticeable. A scar crossing the middle of one is conspicuous. That is why a surgeon may remove more healthy tissue than the defect strictly requires, replacing an entire subunit rather than patching part of it. It appears wasteful and it consistently produces a better result.
Where cancer is the cause, and on the face it frequently is, margins must be confirmed clear before reconstruction begins. Rebuilding over unconfirmed margins buries residual tumour beneath a flap where it grows unseen, and destroys the landmarks needed to find it again. Surgeons either wait for histology and reconstruct a few days later, or use a technique such as Mohs surgery that establishes margins during the procedure. A single-visit excision and reconstruction with neither mechanism is unsafe regardless of convenience.
The choice of method follows the reconstructive ladder, with a facial emphasis on matching. Local flaps are preferred wherever possible because the tissue comes from immediately next door and matches in colour, thickness and texture. Skin grafts are quicker with a minor donor site, and they remain thinner, paler and flatter, giving a patched appearance where they cross a subunit border. Free tissue transfer from the forearm or thigh solves defects nothing simpler can, including missing jaw, and never matches facial skin well.
The forehead flap deserves specific description because it is the standard for larger nasal defects and because patients find it genuinely difficult. Skin from the forehead is swung down on a narrow pedicle carrying its blood supply, left attached across the face for around 3 weeks while it develops new blood supply at the nose, then divided at a second operation. The intermediate period is conspicuous and unavoidable, and patients shown photographs of that stage in advance manage it far better than those who have not.
Swelling after facial reconstruction is dramatic and misleading. It peaks at 48 to 72 hours, bruising spreads downward with gravity into areas that were never operated on, and the face looks considerably worse before it looks better. It settles over 2 to 3 weeks and the contour continues changing for months. Scars are at their reddest and most raised at around 3 months and then fade for a year or more, which is why revision is never planned before then.
Where reconstruction in scarred or heavily irradiated tissue is likely to fail, a facial prosthesis is a genuine option. For the nose, the orbit and the ear after extensive cancer surgery, a well-made prosthesis on implants can look more convincing than a reconstruction in hostile tissue. It needs daily removal and cleaning and replacement every few years. Surgeons who raise it as a real option rather than a last resort are being honest about what reconstruction can and cannot achieve.
Facial reconstruction is unusual among operations in that its result is public. A scar on the abdomen is seen by a handful of people, while a facial reconstruction is seen by everyone the patient meets, every day, for the rest of their life. That reality justifies the additional operations, the staged flaps and the refinement procedures that make facial work more involved than reconstruction elsewhere. It also justifies psychological support, which is routine in specialist units, because the adjustment to a changed face is real regardless of how good the surgery is.
Facial reconstruction plans are built around the tissue that matches, not the tissue that is nearest. Facial skin differs in thickness, colour, texture and sebaceous quality from one region to the next, and skin from the neck or the arm never quite matches skin from the cheek. This is why surgeons will move tissue a considerable distance within the face rather than take an easier graft from elsewhere, and why a forehead flap remains the standard for rebuilding a nose more than a thousand years after it was first described.
Facial reconstruction increasingly uses digital planning, particularly where bone is involved. A scan of the face is used to design cutting guides that shape a fibula or scapula into the exact contour of the missing jaw, printed in advance and used in theatre. It shortens the operation, improves the fit and allows dental implants to be planned into the reconstruction from the start. Not every unit offers it, and where jaw reconstruction is being discussed it is a reasonable thing to ask about.
Facial reconstruction is rarely finished at the first operation, and patients do better when told so plainly. Flaps are deliberately made slightly bulky so they survive, then thinned at a second procedure. Colour takes months to settle and may be improved with laser or camouflage. Eyebrows, eyelashes and nostril rims are added once the underlying reconstruction is stable. Counting on a series of 2 to 4 procedures over a year is a more accurate expectation than hoping the first one will be definitive.
Facial reconstruction requires a surgeon to think in 3 layers rather than 1: the lining, the support and the outer cover. A full-thickness defect of the nose or the cheek has lost all 3, and replacing only the skin leaves a repair that collapses inwards or shrinks. Lining may come from a turned-in flap or a graft, support from cartilage taken from the septum, the ear or a rib, and cover from a local or forehead flap. This layered thinking is why full-thickness facial defects need several operations while partial ones frequently need only one.
Facial reconstruction has to account for the fact that the face moves. A repair that looks correct on the operating table can tug at the corner of the mouth when the patient smiles or pull an eyelid down when they look up. Surgeons therefore plan for the direction of pull and frequently overcorrect slightly, and this is a reason some flaps are anchored to deeper structures rather than relying on skin closure alone.
Facial reconstruction after tumour removal may need to accommodate radiotherapy, which changes the plan in the same way it does in the breast. Irradiated tissue heals less reliably, and a reconstruction performed before radiotherapy can shrink and distort afterwards. Where radiotherapy is expected, surgeons frequently favour bringing in well-vascularised tissue from outside the field and deferring refinements until the treatment is finished and the tissue has settled.
Facial reconstruction is one of the few areas of plastic surgery where camouflage and prosthetics are part of mainstream practice rather than alternatives to it. Medical tattooing restores the colour of a nipple, an eyebrow or a nostril rim, specialist camouflage make-up conceals colour mismatch, and an implant-retained prosthesis can replace an eye, an ear or a nose more convincingly than surgery can. Good units treat these as part of the plan and introduce them early.
Surgeons look for these points at the consultation.
Facial reconstruction suits people with a defect after cancer excision, trauma, burns or a congenital condition, whose cancer margins have been confirmed clear where relevant, who are well enough for the operation proposed, and who understand that function is prioritised over symmetry and that staging is usual.
Reasons a good surgeon will ask you to wait or choose something else.
Facial reconstruction is deferred where cancer margins are unconfirmed, in active infection, in current smokers for flap surgery, in uncontrolled diabetes, where the patient is too unwell for a long anaesthetic, and where a prosthesis would give a better result than reconstruction in heavily irradiated or repeatedly operated tissue.
Ask your surgeon which technique they recommend for you and why.
Neighbouring facial skin is moved into the defect while keeping its own blood supply, placing scars in natural creases and subunit borders.
Skin from the forehead is swung down on a narrow pedicle to rebuild the nose, then the pedicle is divided at a second operation 3 weeks later.
Skin taken from behind the ear, the neck or the collarbone area and laid onto the defect, used where a flap is not needed or not possible.
Tissue from the forearm, thigh or lower leg is moved to the face with its vessels reconnected under a microscope, and bone included where jaw is missing.
Step by step, from arrival to discharge.
Where cancer is the cause, histology is reviewed or margin control used during the procedure before any reconstruction is planned over the defect.
The defect is assessed against the aesthetic subunits of the face, and the surgeon decides whether to replace a whole unit rather than patch part of one.
Eyelid closure, oral competence and nasal airway are planned first, with appearance addressed within whatever those allow.
Local flap, graft or free tissue transfer as the defect demands, with scars placed in natural creases and subunit borders wherever possible.
Where a pedicled flap such as a forehead flap is used, the pedicle is divided at a second operation around 3 weeks later.
Thinning of bulky flaps, contour adjustment and scar revision from around 3 months, once swelling has settled and scars have begun to mature.
Frequencies follow published guidance; your personal risk depends on your health and the surgeon.
Facial reconstruction is planned in a specific order, and understanding it explains most of what a surgeon will and will not do. Function comes first. An eyelid that closes fully protects the eye and prevents blindness; a mouth that seals prevents drooling and allows speech; a nose that breathes matters more than a nose that looks symmetrical. Where those compete with appearance, appearance loses, and a surgeon who explains that trade early is preparing a patient for a result they will otherwise find puzzling.
The second principle is aesthetic subunits. The face divides into regions the eye reads as wholes, such as the tip of the nose, a nostril, the upper lip or a cheek, and scars falling on the borders between them almost disappear while scars crossing the middle of one are conspicuous. That is why a surgeon may remove more tissue than the defect strictly requires, replacing a whole subunit rather than patching part of it. It looks wasteful and it produces a far better result.
Where cancer is the cause, and on the face it frequently is, margins must be confirmed clear before reconstruction. Rebuilding over unconfirmed margins buries residual tumour beneath a flap where it grows unseen and destroys the landmarks needed to find it. Surgeons either wait for histology or use techniques that establish margins during the procedure, and a plan that excises and reconstructs in one visit without margin control is unsafe regardless of how convenient it is.
Finally, expectations. A reconstructed face is judged against the defect rather than against the face that existed before. Tissue brought from the forearm or thigh does not match facial skin in colour or thickness and never fully will. Scars are permanent. Staged flaps look alarming during the weeks when a pedicle crosses the face. Patients shown photographs of that intermediate stage, and of results at a year rather than 6 weeks, cope with the process far better than those shown only finished pictures.
Facial reconstruction trades a defect for scars. Good planning hides them in natural creases and subunit borders, and they remain permanent and visible on close inspection.
Staged flaps need dividing, contours need refining and scars need revising, so facial reconstruction is usually two or three procedures over a year.
Tension from a reconstruction pulling on an eyelid, a nostril or the corner of the mouth, which can affect eyelid closure, breathing or oral competence.
Tissue brought from elsewhere rarely matches facial skin, and a graft or distant flap can remain a visibly different colour and thickness permanently.
Partial or complete loss of the reconstruction, more likely in irradiated tissue and in smokers, sometimes requiring a different method entirely.
Weakness of facial movement where branches of the facial nerve are involved by the disease or at risk during the surgery, which may be temporary or permanent.
Disease recurring beneath or beside a reconstruction, which is why margins are confirmed first and surveillance continues afterwards.
The face swells dramatically after reconstruction and it looks worse before it looks better. Swelling peaks at around 48 to 72 hours, bruising spreads with gravity into areas that were not operated on, and patients who were not warned frequently conclude something has gone wrong. It settles over 2 to 3 weeks and the contour continues changing for months afterwards.
Where a staged flap has been used, particularly a forehead flap to rebuild the nose, there is an intermediate period that is genuinely difficult. A pedicle of tissue crosses the face for around 3 weeks before it is divided, and it is conspicuous. Patients who have seen photographs of that stage in advance manage it; those who have not are frequently distressed by something entirely expected.
Practical restrictions depend on what was rebuilt. Where the mouth is involved, eating is modified for a period. Where the eyelid is involved, the eye is protected and lubricated until closure is reliable. Where a free flap was used, the first 48 hours are about hourly monitoring rather than comfort, and that requirement is why this surgery belongs in a unit that performs it regularly.
Sun protection becomes a permanent part of life rather than temporary advice, particularly where the cause was skin cancer. A reconstructed area burns readily, scars darken permanently with ultraviolet exposure, and someone who has had one facial skin cancer is at real risk of another. Surveillance continues alongside for years.
Days 1-3
Where a free flap was used, hourly checks for the first 48 hours. Swelling peaks and looks dramatic. Feeding and speech may be affected where the mouth is involved.
Days 4-21
Facial sutures out at 5 to 7 days. Where a forehead flap was used, the pedicle is divided at around 3 weeks. Flying is usually cleared at around 2 weeks.
Weeks 4-8
Return to work varies with the site and the job. Sun protection is essential. Swelling continues to settle and contours change.
Months 2-6
Contour adjustments, scar revision and thinning of bulky flaps are planned from around 3 months once tissue has settled.
Months 12-18
Scars mature and colour differences settle as far as they will. Surveillance continues where cancer was the cause.
A well-planned facial reconstruction is frequently unremarkable at conversational distance by a year, particularly where local tissue was used and scars fall on subunit borders.
Grafts and distant flaps do not match. A skin graft stays paler and flatter, and forearm or thigh tissue on the face remains a different colour and thickness permanently, which is the cost of solving a problem nothing simpler could.
Function is usually restored reliably: an eyelid that closes, a mouth that seals, a nose that breathes. Symmetry is less predictable and frequently incomplete.
The honest assessment point is 12 to 18 months. Swelling obscures contour for months, scars peak in redness at three, and staged plans are not finished until the last refinement has settled.
Facial reconstruction after cancer, trauma or a congenital condition is funded in most health systems, and the funded pathway usually includes the cancer surveillance that should follow. That is worth establishing before paying privately, because the surveillance matters as much to long-term health as the reconstruction does.
Where it is paid for privately, the prices on this site come from verified clinic records for each named procedure. The range is very wide, from a local flap under local anaesthetic to free tissue transfer with several hospital nights and hourly monitoring.
The cost most often understated is staging. Pedicled flaps need dividing at a second operation, bulky flaps need thinning, and scar revision waits a full year. Two or three procedures across a year is the norm, which for a travelling patient means more than one trip.
Why quotes for the same procedure differ, so you can compare packages fairly.
Options to weigh before deciding, surgical and non-surgical.
Letting a wound heal on its own, which on concave facial surfaces frequently gives an excellent result with no surgery and easy monitoring.
Simpler and quicker, and deliberately chosen where recurrence risk is high because it leaves the area easy to examine.
For the nose, orbit or ear in heavily irradiated tissue, frequently more convincing than a reconstruction that would struggle to heal.
Waiting until cancer treatment is complete and tissue has settled, which is standard where radiotherapy is planned.
Accepting the initial reconstruction and refining the scars after a full year, when they have matured.
Ask the same questions at every consultation so you can compare answers.
Facial reconstruction divides the face into regions the eye reads as single wholes, such as the nasal tip, a nostril, the upper lip or a cheek. Scars falling on the borders between them are barely noticeable; scars crossing the middle of one are conspicuous.
That is why a surgeon may remove more tissue than the defect requires, replacing an entire subunit rather than patching part of it. It seems wasteful and it consistently produces a better-looking result.
Because the consequences of facial reconstruction differ in kind between sites. An eyelid that cannot close leads to corneal damage and can cost sight. A mouth that cannot seal causes drooling and impairs speech. A blocked nose affects breathing and sleep.
Symmetry, by contrast, is a matter of appearance. Where the two compete, surgeons choose function, and understanding that in advance explains results that otherwise look like compromises.
Skin from the forehead is swung down for facial reconstruction on a narrow strip of tissue carrying its blood supply to rebuild the nose, left attached for around 3 weeks while it develops new blood supply, then divided at a second operation.
It is the standard method for larger nasal defects and gives an excellent colour match. The intermediate weeks, with a pedicle crossing the face, are conspicuous and worth seeing photographs of beforehand.
Because facial reconstruction over unconfirmed margins buries any residual tumour beneath a flap, where it grows unseen. The reconstruction also destroys the anatomical landmarks needed to find it again.
Surgeons either wait for histology before rebuilding, or use a technique that confirms margins during the procedure. Excising and reconstructing in one visit without margin control is unsafe however convenient it appears.
Local flaps match well in facial reconstruction because the tissue comes from next door. Skin grafts and tissue brought from the forearm or thigh do not, and frequently remain visibly different in colour and thickness permanently.
Where matching matters most, surgeons use the closest tissue available even if it means a more complex operation. It is one of the main reasons a local flap is preferred over a graft on the face.
Usually two or three over a year. Staged flaps need dividing, bulky reconstructions need thinning, contours need refining and scars are frequently revised once everything has settled.
Revision is planned rather than a sign of failure. Scar revision in particular waits a full year, because facial scars keep improving for that long on their own.
Facial reconstruction can affect the facial nerve, where disease involves it or where surgery passes close to its branches. Weakness may be temporary from bruising and swelling, or permanent where a branch was divided or removed with a tumour.
Where a nerve must be sacrificed, it can sometimes be grafted at the same operation. Ask specifically whether the nerve is at risk in your case and what the plan is if it is.
Sometimes, particularly for the nose, the eye socket and the ear after extensive facial cancer surgery in heavily irradiated tissue. A well-made prosthesis on implants can look more convincing than a reconstruction in difficult tissue.
It requires daily removal and cleaning and replacement every few years. Surgeons who raise it as a genuine option rather than a fallback are being honest about what reconstruction can achieve in scarred or irradiated beds.
Facial swelling peaks at 48 to 72 hours and looks alarming, settles substantially over 2 to 3 weeks, and continues resolving for months. Bruising spreads downward with gravity into areas that were not operated on.
The contour keeps changing for 6 months or more, particularly after flap reconstruction, which is why refinement procedures are not planned before around 3 months.
Usually, where the cause is cancer, trauma, burns or a congenital condition. Most health systems treat restoring facial function and form after disease quite differently from cosmetic surgery.
It is worth pursuing before paying privately, particularly where cancer surveillance needs to continue. A funded pathway includes that follow-up, which private treatment abroad generally does not.
Small local facial flap repairs travel reasonably well. Staged reconstruction, free tissue transfer and anything following cancer do not, because of the intervals between stages and the surveillance that follows.
Where the cause was skin cancer, continuing skin checks matter as much as the reconstruction, and those belong where you live. Bring your histology and radiotherapy records to any consultation.
Someone who performs facial reconstruction regularly, works within a head and neck or skin cancer team where relevant, and talks about subunits and function rather than only about closing the hole.
Ask how margins are confirmed, how many stages they expect, and to see their own patients at a year. Ask also to see an intermediate photograph if a staged flap is planned, because that is the part patients find hardest.
Facial reconstruction divides the face into regions with their own borders, such as the nose, the upper lip and the cheek. Replacing a whole subunit rather than patching part of one hides the scars in natural boundaries.
It is why a surgeon may enlarge a defect before rebuilding it, which sounds counterintuitive. A slightly larger repair that sits within natural borders looks better than a smaller one that crosses them.
Around 2 months for a facial reconstruction of this kind. The flap is raised and set into the nose at the first stage, the pedicle stays attached for 3 weeks while the flap builds its own blood supply, then it is divided and the forehead closed.
Some surgeons add an intermediate thinning stage, which makes it three operations. It is the main reason nasal reconstruction is a poor fit for a single trip abroad.
Facial reconstruction donor sites depend on the flap. A forehead flap donor site is closed directly and the residual scar sits vertically in the midline, healing well. A radial forearm flap leaves a skin graft on the forearm that is permanently visible.
Ask specifically about the donor site, since it is frequently the part people are least prepared for. A hidden facial scar can come at the price of an obvious arm one.
Where a facial nerve has been lost, movement can be restored by nerve grafting, nerve transfer or by transplanting a muscle with its own nerve supply, but the result takes 6 to 12 months to appear.
Static procedures such as a sling or an eyelid weight give symmetry at rest and protect the eye without restoring movement. Most facial palsy plans combine the two.
American Society of Plastic Surgeons2024Professional society
National Institute for Health and Care Excellence2004Clinical guideline
NHS2024Regulator
Consultation request
Tell us the procedure and destination you are considering. We forward your request to the verified clinic you select.