Plastic surgery restores form and function through reconstructive procedures, cosmetic enhancements, and body contouring.
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The consultation is the foundational step in the reconstructive journey. It is a comprehensive medical evaluation where the surgeon assesses the defect (or potential defect) and the patient’s overall health. Unlike a purely cosmetic consultation, the focus here is on pathology, anatomy, and functional restoration.
The surgeon reviews the pathology reports to understand the nature of the skin disease. They examine the site to determine whether deeper structures, such as muscle, bone, or nerve, are involved. This phase sets the strategic roadmap, determining whether a simple closure, a graft, or a complex flap is the best course of action.
For complex defects, especially on the face, modern technology plays a crucial role. 3D imaging systems enable surgeons to capture high-resolution topographical maps of the patient’s anatomy. This helps plan the precise dimensions of flaps and visualize the outcome.
Digital mapping is also used to track lesions and plan margins. In cases of extensive skin cancer, this technology ensures that reconstruction is planned with accurate spatial awareness, minimizing the risk of distorting facial features such as the eyelids or lips.
The “pinch test” is a critical part of the physical exam. The surgeon manually assesses the skin laxity around the defect to determine whether it can be mobilized for closure. They evaluate the skin’s elasticity, thickness, and sun damage.
Skin that is tight or heavily scarred may not support a local flap, necessitating a graft or tissue from a distant site. The surgeon also checks for “reservoir” areas—loose skin in the neck, temple, or cheek—that can be recruited to cover the wound without creating tension.
Blood supply is the lifeblood of any reconstruction. For flap surgery, identifying the feeding vessels is mandatory. The surgeon uses a handheld Doppler probe to locate and map the perforator arteries that will supply the flap.
This “vascular mapping” ensures that the chosen tissue has a robust blood supply. In patients with vascular disease or smokers, this assessment is even more critical to prevent flap necrosis (tissue death). It allows the surgeon to design the flap around a known, reliable vessel.
Reconstructive surgery places a metabolic demand on the body. Patients must be medically optimized to ensure proper healing. This involves controlling blood sugar in people with diabetes, managing hypertension, and correcting any nutritional deficiencies.
The surgeon reviews all medications. Blood thinners (anticoagulants) may need to be paused or bridged to prevent a hematoma. Immunosuppressive drugs may be adjusted to balance the risk of rejection with the need for wound healing. Optimization minimizes the risk of systemic complications during recovery.
Nicotine is a potent vasoconstrictor that jeopardizes the success of reconstructive surgery. It shrinks the tiny blood vessels that are essential for flap survival and graft take. Smoking increases the risk of wound failure, infection, and skin necrosis significantly.
A strict cessation protocol is enforced. Patients are required to stop all nicotine products—vapes, patches, gum—for at least 4 weeks before and after surgery. Urine cotinine tests may be used to verify compliance. This is a non-negotiable safety measure for flap surgery.
Wound healing requires protein and energy. Malnutrition is a silent enemy of reconstruction. The surgeon evaluates nutritional markers, such as albumin and Prealbumin, to ensure the patient has the building blocks for repair.
Patients may be placed on a high-protein diet or given supplements (Zinc, Vitamin C, Arginine) in the weeks leading up to surgery. This “pre-habilitation” boosts the immune system and strengthens the body’s ability to repair tissue.
Facing skin cancer or a disfiguring skin disease is traumatic. The surgeon assesses the patient’s emotional state and support system. Realistic expectations are crucial; patients must understand that reconstruction improves appearance but creates scars.
The consultation includes a discussion about the recovery process, which can be visually confronting initially. Ensuring the patient has a supportive home environment and the mental resilience to handle the healing journey is a key part of preparation.
Reconstruction often involves a multidisciplinary team. The surgeon coordinates with the dermatologist (Mohs surgeon) to time the reconstruction immediately after cancer clearance. For head and neck cancers, coordination with oncologists and radiation therapists is essential.
This teamwork ensures a seamless transition from treatment to reconstruction. It prevents delays that could leave open wounds vulnerable to infection and ensures that the reconstruction plan does not interfere with future cancer treatments like radiation.
Recovery from reconstructive surgery varies by procedure. A simple closure may require only wound care, while a flap may require immobilization and activity restrictions. The patient is advised on how to prepare their home (“nesting”) for recovery.
Patients need to arrange transportation, time off work, and assistance with daily tasks, such as dressing changes. If the surgery is on the face, sleeping with the head elevated is required. Planning these logistics reduces stress and ensures compliance with post-op instructions.
To minimize infection risk, the skin is prepped before surgery. Patients may be instructed to wash with an antibacterial soap (like Hibiclens) the night before and the morning of surgery.
For facial surgery, patients are asked to arrive with a clean face, free of makeup or lotions. Men may need to shave, although the surgeon typically handles hair removal immediately before the procedure to avoid micro-abrasions that could harbor bacteria.
Send us all your questions or requests, and our expert team will assist you.
For more minor defects, we often use local anesthesia, so you are awake but numb. For larger reconstructions or if you are anxious, we can use twilight sedation or general anesthesia so you sleep through the procedure comfortably.
Usually, yes. Blood thinners increase the risk of bleeding and hematoma (blood collection) under the flap, which can damage the tissue. We will coordinate with your cardiologist to stop them safely for a few days around the surgery.
The main categories of cancer are carcinomas (starting in the skin or lining of organs), sarcomas (starting in connective tissues like bone and muscle), leukemias (blood cancers), and lymphomas (immune system cancers).
Nothing. Keep the area clean and dry. Do not apply creams, ointments, or bandages unless your doctor instructs you to. We want the skin to be in its natural state for the surgical prep.
Understand that scars are inevitable but will fade. We recommend buying silicone scar gel or sheets beforehand so you are ready to start scar therapy as soon as the stitches come out and the wound is fully healed.
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