Basal Cell Cancer: Reconstruction of the Nose

About Dr. Hootan Zandifar

Dr. Hootan Zandifar is board-certified in Otolaryngology and fellowship-trained in Facial Plastics and Reconstructive Surgery. Dr. Zandifar is the director of the Skin Center at the Osborne Head and Neck Institute based at Cedars-Sinai Medical Towers.

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About Dr. Ryan Osborne

Ryan F. Osborne, M.D. is the Director of Head and Neck Surgery at OHNI and is an internationally renowned expert in head and neck oncology. He has developed a special interest for the treatment of parotid gland tumors and focuses on the use of minimally-invasive techniques in the care of patients needing parotid surgery.

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I had a small bump on my nose that my dermatologist said was basal cell cancer. I had it resected and now I have a huge hole in my nose. I need my face to look its best for work and would prefer to have the best result possible. What should I do?

Figure 1: Defect involving the left nasal ala

Case Study

A patient in his sixties noticed a small bump along the left tip of his nose. When he saw his primary care physician he was referred to a dermatologist. A shave biopsy of the lesion was performed and found to be positive for basal cell carcinoma, the most common form of skin cancer. The patient was referred to a Mohs surgeon for resection of the lesion. Arrangements were made for the patient to follow up with Dr. Zandifar following the resection to have the ensuing defect reconstructed. The defect involved the region of the nose referred to as the nasal ala. He underwent a composite graft reconstruction of the nose. There was no need for a large forehead or cheek graft and 3 months later the patient is very happy with the results and is able to breathe through his nose with no difficulty.


Defects of the nasal ala are difficult to reconstruct for several reasons. One reason is that the natural curvature of the nose, especially the transition from the outside to the inside of the nostril, is very hard to re-create. Secondly, scarring in the nasal region can cause disfigurement and pulling of the ala. Lastly, alteration to the shape of the ala can change airflow through the nose and in some cases, make it difficult or uncomfortable to breathe.

surgery-basal-cell3Figure 2: Three months after reconstruction by Dr. Hootan Zandifar

Reconstruction of the nasal ala requires meticulous planning and customization of a procedure suitable to the patient’s specific anatomy. Many times a graft of skin with extra support is needed to reconstruct the alar region of the nose. These grafts are usually harvested from the ear and carry cartilage with them to prevent collapse of the nasal ala. Conversely, other procedures can involve the transfer of a large skin flap from the cheek or forehead.

Nasal reconstruction should ideally be performed by a Facial Plastic and Reconstruction Surgeon with extensive experience. These surgeons are familiar with the nuances of the nasal architecture and can avoid common pitfalls seen when outdated or inappropriate procedures are used.

The physicians of the Osborne Head and Neck Institute are board certified in both otolaryngology and facial plastics and reconstructive surgery. This unique combination of specialties allows the physician to address the functional as well as cosmetic aspects of nasal reconstruction.

To learn more about Dr. Hootan Zandifar or nasal reconstruction following skin cancer resection, please visit: