Craniofacial & Facial Reconstruction
Regional flap facial reconstruction moves living tissue from a nearby area, keeping its blood supply attached, to repair a facial defect.
How is this different from a skin graft?
A regional flap keeps its own blood supply attached while it is moved.
A skin graft is detached tissue that must develop a blood supply from the wound beneath it. A flap can provide thicker coverage when a graft alone would not meet the repair needs.
Will I need more than one operation?
Some regional flaps are completed in stages.
The tissue may remain connected by a bridge of skin and blood vessels until it has established circulation in its new position. A later procedure can separate that connection and refine the repair.
Is this cosmetic facial surgery?
Its main purpose is to rebuild missing or damaged tissue.
Appearance matters, but protecting structures and restoring function may be the first priorities. It is not the same as a facelift.
01 · Overview
Regional flap reconstruction uses skin and sometimes underlying fat, fascia or muscle from a nearby area to repair the face. Surgeons may consider it after skin cancer removal, injury or another cause of tissue loss. The size, depth and location of the wound guide the choice. [1]
Unlike a small local flap that rearranges tissue immediately beside a wound, a regional flap reaches from a nearby donor area on an attached blood supply, called a pedicle. A free flap is different: tissue is fully detached from another part of the body, then its blood vessels are reconnected using microsurgery. The terms local and regional sometimes overlap. [1]
The surgeon considers both the facial repair and the area providing tissue. The plan may also require cartilage, lining or other support that a skin flap alone cannot replace. If cancer removal is involved, reconstruction is coordinated with confirmation that the tumor has been adequately treated. [2]
A flap carries blood flow into the repair and can add tissue thickness. This can matter when bone, cartilage or other structures are exposed or when the wound bed is less suitable for a graft. Neither approach is best for every wound.
It may be closed directly, covered with a graft or allowed to heal with wound care, depending on its size and location. It can have its own scar, tenderness, numbness or contour change. Ask to see where the donor site will be and how it will be managed.
02 · Concerns & Goals
A facial wound can affect comfort, appearance and everyday function. The plan starts with what needs repair and what matters most to you.
A defect after cancer removal or injury may need living tissue coverage to protect the structures underneath.
The repair may need to support eyelid closure, lip movement or a nasal airway, depending on the location.
Tissue loss can change facial contours. Rebuilding the outer skin may be only one part of restoring the area.
You may want to discuss color, texture, thickness and scar placement, along with what cannot be fully restored.
03 · Options
These are examples of regional flaps, not interchangeable choices. Your surgeon recommends a design based on the defect, available tissue and blood supply.
Forehead tissue can rebuild parts of the nose.
Tissue near the cheek crease can repair selected nasal or nearby facial defects.
Tissue from the temple can provide coverage or support for deeper repairs.
Tissue beneath the chin can cover selected lower facial or mouth defects.
Flap names describe the donor tissue and blood supply. The final design may combine a flap with grafts or other reconstruction, and the planned stages should be explained before surgery. [1].
Sometimes. Timing depends on how the cancer is removed, how clear margins are confirmed and whether other treatment is expected. Some wounds are temporarily dressed before definitive reconstruction.
A free flap can bring a larger amount or different type of tissue from elsewhere in the body. A regional flap may meet the repair needs without microsurgical vessel reconnection. Large or complex defects may still be better served by a free flap.
04 · Results
The aim is stable tissue coverage that supports healing.
The plan balances function, contour and appearance.
Early appearance is not the finished result.
Reconstruction repairs the defect; it does not replace follow-up for the condition that caused it, including skin cancer surveillance. [2]
05 · Recovery
Returning to work does not mean fully healed. Follow your surgeon’s instructions; strenuous activity requires clearance.
Recovery depends on the flap, donor site and number of stages. Your surgical team should provide instructions tailored to both sites and explain how the flap will be checked.
Step 1 · Day of surgery
The team checks circulation in the flap and manages pain, bleeding and dressings. Discharge the same day or a hospital stay depends on the extent of reconstruction and your health.
Step 2 · First days to weeks
Swelling, bruising, tenderness and altered sensation can occur. Follow-up checks assess the flap and donor site. Ask your surgical team whether compresses are appropriate and exactly how to use them.
Step 3 · After the surgeon confirms adequate healing
A later operation may divide a tissue bridge, reposition tissue or refine its thickness. The interval is based on the flap's circulation and healing, not a single schedule for everyone.
Step 4 · Over the following months
Scars and swelling gradually change. Your team can explain when scar care, sun protection measures or discussion of revision are appropriate.
Use your surgical team's instructions for wound care and activity. Restrictions may change after each stage.
Ask the team what color, swelling and drainage they expect for your flap. Sudden changes in color or temperature, rapidly increasing swelling or worsening pain need prompt assessment. Do not wait for the next scheduled visit.
Only as your team instructs. Dressings, cleaning and ointments depend on the flap and stage of healing. Ask for a demonstration and do not press on, reposition or remove an attached tissue bridge.
06 · Safety
Temporary swelling, bruising, soreness, numbness and a noticeable donor-site scar can occur. A staged flap may also have a visible tissue bridge until a later operation.
Part or all of the moved tissue may not survive. Urgent treatment, wound care or another reconstruction may be needed.
Blood or fluid can collect beneath the tissue and may require drainage or another procedure.
Either the facial repair or donor site can become infected, open or take longer to heal.
Scars may widen or tighten. Bulk, asymmetry, color differences or donor-site hollowing can remain.
Numbness, nerve injury or tissue tightness may affect movement. Depending on the repair, eyelid position, nasal airflow or mouth function can change.
Medication reactions, breathing problems or blood clots can occur. Your anesthesia and surgical teams assess your individual risks.
Discuss these risks and your individual health history with your surgeon. [1]
07 · Costs
Compare written estimates for the same planned scope, including the flap, donor-site repair and expected stages. Insurance coverage and your share of costs depend on the reason for reconstruction, your plan and authorization requirements.
Surgeon
Surgeon services for the facial repair, donor-site closure and planned later stages.
Ask your surgeonAsk whether flap division, contour refinement and unplanned revision are included or billed separately.
Facility
Anesthesia services and the operating room or hospital setting.
Ask your surgeonConfirm separate bills, network status and whether each stage has its own facility and anesthesia charges.
Supplies
Dressings, prescribed medicines and postoperative visits.
Ask your surgeonAsk which supplies and visits are included and how additional wound care is billed.
TRC
Any separately offered scheduling, care-coordination or administrative support.
Ask TRCAsk whether there is a separate charge, what it covers and whether the service is optional.
Your written estimate should explain the services included, any separate charges, and payment terms.
08 · Questions
Nearby tissue may offer a useful color and texture match, but a perfect match is not assured. Thickness, hair growth and sun exposure can also affect how it looks.
For an interpolation flap, the bridge is usually divided during a planned later operation. Other regional flap designs keep their blood supply under the skin and do not need an external bridge.
Sensation may improve over time, but some numbness or altered feeling can remain at the repair or donor site. Recovery depends on the tissues and nerves involved.
You can discuss that preference, but a one-stage option may not provide suitable coverage or support. Ask what would be gained or compromised compared with a staged flap.
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