How is a flap different from a skin graft?
A local flap keeps a connection to its blood supply as nearby tissue is moved into a wound.
A skin graft is detached from another site and must develop a blood supply from the wound beneath it.
Face & Neck · Reconstruction
Local Facial Flap Reconstruction
Local facial flap reconstruction moves nearby skin and underlying tissue, while preserving its blood supply, to repair a facial wound or defect.
Is this a facelift?
No. The aim is to repair a defect, not to lift the face for cosmetic rejuvenation.
The repair may also help protect an eyelid, support a nostril, or preserve lip movement, depending on the location.
Will I need more than one operation?
Some repairs are completed in one operation; others need planned stages or later refinement.
The wound's size, depth, and location help determine the approach.
01 · Overview
Repairing a facial wound with nearby tissue
A local facial flap uses tissue close to a wound to cover an area that cannot be closed well by simply bringing its edges together. Keeping a blood-supply connection helps support the moved tissue while it heals. [1]
Repair may follow skin cancer removal or an injury. Your surgeon considers skin color, thickness, available looseness, and nearby structures when planning the incisions. The goal is coverage that also respects facial movement and contour. [1]
A local flap differs from a free flap, which transfers tissue from a distant part of the body and reconnects blood vessels. It also differs from a skin graft and a cosmetic facelift. A consultation is needed to decide which repair fits your wound and health. [2]
- Main purpose
- Restore coverage and support facial function
- Tissue source
- Skin and soft tissue next to the wound
- Anesthesia
- Local anesthesia, sometimes with sedation or general anesthesia
- Scars
- Along the repair and the incisions used to move tissue
Why might the incision be larger than the original wound?
Moving nearby skin without excessive tension often requires incisions beyond the wound itself. These allow tissue to slide or turn into position and let the donor area close. Ask your surgeon to draw the expected incision pattern.
How does skin cancer treatment affect the plan?
Reconstruction is coordinated with the clinician removing the cancer. The final wound may be larger or deeper than expected, so the flap plan may change once removal is complete and the team has assessed whether the cancer margins are clear.
02 · Concerns & Goals
What brings people to a consultation
A wound after skin cancer removal, an injury, or another operation can affect both appearance and everyday function. Your surgeon will assess what the area needs.
An open area after treatment
Skin cancer removal or another operation may leave a wound that needs tissue coverage rather than a straight-line closure.
Pulling near an eyelid or lip
The direction of tension matters. Repair should account for eyelid closure, lip position, and other nearby functions.
A change in contour
Missing skin or soft tissue can leave a hollow, uneven edge, or loss of support that needs careful planning.
Questions about scars
A flap creates scars around both the repair and the tissue movement. Their position and likely evolution are worth discussing before surgery.
03 · Options
How the approaches differ
Local flaps are designed around the wound and nearby tissue. These are common movement patterns, not interchangeable choices; your surgeon may combine or modify them.
Advancement flap
Nearby tissue slides forward into the wound.
How it worksIncisions release adjacent skin so it can advance while keeping an attached blood supply.
May suitSelected wounds with enough nearby skin mobility.
Main tradeoffTension and extra skin folds must be managed to avoid pulling on nearby features.
Rotation flap
Tissue turns along a curved incision.
How it worksA curved flap swings into the defect from an adjacent area.
May suitSelected wounds where a curved design can distribute tension.
Main tradeoffThe incision may extend well beyond the wound, and contour adjustments may be needed.
Transposition flap
Nearby tissue pivots over an intervening area into the wound.
How it worksThe surgeon redirects tissue from an area with more available skin while maintaining its attached base.
May suitSelected defects where tissue immediately beside the wound would pull in an unfavorable direction.
Main tradeoffAdditional scar lines and temporary or persistent raised fullness can occur.
Island flap
A skin island moves on an underlying tissue connection.
How it worksThe visible skin is released around its edges while deeper tissue maintains its blood supply.
May suitSelected small facial defects where deeper tissue mobility allows coverage.
Main tradeoffMovement is limited by the blood-supply connection, and bulk or contour differences may remain.
These terms describe how tissue moves. The safest design depends on the wound, blood supply, previous treatment, and the structures that need protection. [1] [2].
Can I choose the flap with the shortest scar?
Scar length is only one consideration. A slightly longer incision may allow less tension or better protect an eyelid, nostril, or lip. Ask how each reasonable option balances coverage, function, and scarring.
Are all facial flaps local flaps?
No. Some facial repairs use regional tissue, such as a forehead flap for certain nasal wounds, or a free flap from a distant site. These can involve different stages and recovery needs from a local flap.
04 · Results
What may improve and what may remain
Coverage and function
The first priorities are a healed wound and protection of nearby structures.
- The plan may address eyelid closure, nasal support, or lip movement.
- Some wounds also need deeper reconstruction beyond skin coverage.
Color and contour
Nearby tissue may provide a useful match, but differences can remain.
- Swelling can initially make the flap look raised or uneven.
- Thickness, redness, and contour may change as healing progresses.
Scars and refinement
Scars are permanent, though their appearance usually changes over time.
- Scar maturation takes months and may continue for a year or longer.
- Persistent bulk, tightness, or asymmetry may lead to a discussion about revision.
Healing varies with the wound, repair, circulation, and health history. Reconstruction does not replace skin cancer follow-up when cancer treatment caused the wound. [1]
05 · Recovery
Planning your recovery
Recovery at a glance
- Stay after surgery
- Determined by Your Surgeon
- Initial recovery at home
- Varies by Individual
- Return to desk work
- Varies by Procedure and Work Activity
- Light daily activities
- Based on Individual Recovery
- Strenuous exercise
- Based on Surgeon Clearance
Returning to work does not mean fully healed. Follow your surgeon’s instructions; strenuous activity requires clearance.
Your recovery plan should match the flap's location and complexity. Early return to daily activities does not mean the tissue has fully healed.
Step 1 · Day of surgery
Treatment day
The team checks the repair and explains dressing care, medicines, and follow-up. Arrange an escort if sedation or general anesthesia is used, or if your team requires one.
Step 2 · First several days
Early protection
Swelling, bruising, and tenderness are common. Follow your team's instructions about pressure, positioning, and wound care, and report concerning changes promptly.
Step 3 · Often within the first week
Wound review
Your team checks healing and decides when any removable stitches should come out. Timing depends on the site and repair; additional checks may be needed.
Step 4 · Following weeks and months
Scar and contour settling
Activity usually increases gradually with clearance. Scar care and any later refinement are discussed once the wound is ready and swelling has settled.
Planning everyday activities
ActivityGeneral planning contextWhat affects the plan
Desk workPlanning context: Some people return within days; others need longer.What affects it: Dressings, swelling, discomfort, and the demands of your job affect timing.
Exercise and liftingPlanning context: Resume according to your surgeon's restrictions.What affects it: Straining can increase bleeding or tension across the repair.
DrivingPlanning context: Wait until your team clears you and you can drive safely.What affects it: Sedating medicines, eye-area swelling, and dressings can interfere with vision and reaction time.
Glasses, masks, and shavingPlanning context: Ask how to avoid rubbing or pressure over the flap.What affects it: The repair's location determines when these everyday activities are comfortable and safe.
These are planning considerations, not a personal clearance schedule. Follow the surgical team's instructions.
Before your procedure
- Review your medical history, previous facial surgery, radiation treatment, and wound-healing problems.
- Share all medicines, supplements, and allergies; ask which medicines need adjustment rather than stopping them yourself.
- Discuss smoking, vaping, and nicotine use and the team's plan to reduce healing risks.
- Confirm how cancer removal or other wound treatment will be coordinated with reconstruction.
- Arrange transportation and home support appropriate to your anesthesia and repair.
- Get written wound-care instructions, follow-up dates, and daytime and after-hours contact numbers.
Can I use a cold compress for swelling?
Ask your surgical team whether compresses are appropriate and exactly how to use them.
When can I start scar massage or scar products?
Wait for your surgical team to confirm that the wound is closed and ready. Massage, silicone products, makeup, and sun protection need to be tailored to the site and stage of healing.
06 · Safety
Risks and what your clinician assesses
Temporary swelling, bruising, tenderness, tightness, and altered sensation can occur. Your team should explain which changes are expected for your flap and which need a prompt call.
Bleeding or a blood collection
Bleeding beneath the flap can cause swelling and pressure and may need drainage or another procedure.
Infection
Infection may require antibiotics or further treatment and can delay healing.
Reduced blood supply
Part or all of the flap may fail to survive if circulation is inadequate, potentially requiring wound care or another repair.
Delayed healing or wound separation
The incision may heal slowly or open, especially when circulation is poor or tension is high.
Scarring or contour changes
Raised scars, persistent fullness, asymmetry, or pulling on an eyelid, nostril, or lip may remain and sometimes need revision.
Nerve or anesthesia complications
Numbness may persist, and nerve injury can affect movement. Local anesthesia, sedation, or general anesthesia also carries risks that depend on your health and the planned treatment.
Discuss these risks and your individual health history with your surgeon. [2]
What your clinician assesses
- Wound size, depth, location, and nearby facial function
- Local skin mobility, circulation, scars, and previous radiation
- Health conditions, medicines, and nicotine exposure that affect healing
- Treatment goals, anesthesia needs, and ability to attend follow-up
07 · Costs
What makes up the Total Procedure & Care Cost
Compare written estimates for the same planned scope, including the repair, anesthesia, follow-up, and any expected stages. Insurance coverage depends on your plan and the reason for reconstruction.
Surgeon
Surgical care
Surgeon services for planning and performing the flap repair.
Ask your surgeonAsk whether wound preparation, additional stages, or later revision are included or billed separately.
Facility
Anesthesia and facility
The treatment setting and any anesthesia services.
Ask your surgeonConfirm the planned anesthesia, facility charges, and network status of each billing provider.
Supplies
Supplies and follow-up
Dressings, prescribed medicines, and postoperative visits as listed in the estimate.
Ask your surgeonAsk what you must purchase and how unplanned visits or wound treatment are billed.
TRC
Patient Services
Any separately listed administrative or care-coordination services.
Ask TRCAsk whether a separate charge applies, what it covers, and whether it is optional.
Your written estimate should explain the services included, any separate charges, and payment terms.
08 · Questions
Common questions
Can the repair happen on the same day as Mohs surgery?
Sometimes. Timing depends on completion of cancer removal, the final wound, and coordination between clinicians. Some repairs are scheduled for a later day.
Will the flap look like normal skin immediately?
No. Swelling, bruising, redness, and a raised contour can be noticeable early on. Nearby tissue may blend over time, but a perfect match is not assured.
Will hair grow on the moved skin?
Hair-bearing skin generally retains its hair follicles. Your surgeon considers this when choosing tissue, particularly near the beard, eyebrows, and hairline.
Does reconstruction mean the cancer is cured?
No. Reconstruction repairs the wound. Cancer clearance and ongoing surveillance are separate parts of care managed by your treating clinicians.
0 consultation questions in your plan
View in My TRC workspaceMy Aesthetic Plan
Prepare for your consultation
Bring these to help your consultation:
- Confirm the repair plan, alternatives, and possibility of additional stages.
- Arrange support and review personalized wound-care and activity instructions.
- Keep follow-up dates, urgent contact information, and the written estimate accessible.
View My Aesthetic Plan
Choices stay in this visit until saving to your account completes. Nothing is sent to a clinician.
Sources
- [1]American Society of Plastic Surgeons: Skin Cancer RemovalReconstruction after skin cancer removal; local flap and skin graft repair; consideration of facial function, scars, healing, and continued cancer follow-up.
- [2]Cleveland Clinic: Flap SurgeryFlap blood supply, local versus distant tissue transfer, flap planning, recovery monitoring, and risks including bleeding, infection, impaired healing, and flap loss.
Photographs are illustrative scenes, not patients, staff, facilities or outcomes. This information does not replace a personal assessment by your treating clinician.