Facial reconstruction

What is facial reconstruction?

Facial reconstruction is surgery to rebuild part of the face after something has been lost or damaged — most commonly after a skin cancer is removed, but also after injury (trauma) or to address a congenital difference present from birth. The aim is to restore both how the face looks and how it works, because the face does important jobs: the eyelids protect the eye, the lips keep the mouth closed, and the nose shapes breathing.

The right method depends on the size, depth and position of the defect. Small wounds may simply be stitched directly. Larger ones are often repaired with a 'local flap' — healthy skin moved from nearby, keeping its own blood supply — or with a 'skin graft', a thin layer of skin taken from elsewhere. Complex defects exposing bone or deep structures may need a 'free flap', where tissue is transferred from another part of the body and its blood vessels reconnected under a microscope.

Reconstruction is usually planned around the cancer or injury treatment, not the other way round. Clearing the tumour fully comes first; the reconstruction works with whatever defect that leaves. It can achieve a great deal, but some scarring, asymmetry or change in feeling is usual, and more than one operation is sometimes needed to get the best result.

Types & techniques

There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.

Options at a glance

These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.

Preparing for your surgery

• If reconstruction follows skin-cancer removal, the cancer team may first confirm the tumour is fully cleared (sometimes with Mohs surgery) before rebuilding.
• Tell your surgeon about smoking, diabetes, blood-thinning medicines and previous facial surgery or radiotherapy, as these affect healing and flap survival.
• Stopping smoking or nicotine is particularly important, as it raises the risk of flap and graft failure.
• Discuss what the defect involves and which method is planned, including where any graft or flap will be taken from.
• Arrange time off and a lift home; major or free-flap surgery needs a longer recovery and hospital stay.
• Ask about scar position, likely appearance and whether more than one operation may be needed.
• Arrange help at home for the first days, especially if a dressing affects your vision or eating.

What happens

For smaller reconstructions, the surgery is often done under local anaesthetic, sometimes with sedation. The surgeon repairs the defect using the planned method — closing it directly, moving a local flap, or placing a skin graft — and uses fine stitches to position the edges so the scar falls in natural lines where possible.

Larger or free-flap reconstructions are done under general anaesthetic and take longer. Tissue is transferred and, for a free flap, its blood vessels are stitched to vessels near the face under a microscope. Dressings, and sometimes drains, are applied. With free flaps, the team monitors the flap's blood supply closely in the first days.

Who is involved depends on the case: a plastic surgeon, sometimes alongside a dermatologist (for Mohs skin-cancer surgery), an oculoplastic surgeon for eyelid work, or a head-and-neck team. After smaller surgery most people go home the same day; after major reconstruction an inpatient stay is usual.

Is this operation right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

Anaesthetic choices

The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.

The main risks specific to facial reconstruction are scarring, asymmetry, altered feeling and — particularly with skin grafts — partial healing failure (necrosis). One large study found grafts had notably higher rates of haematoma and necrosis than local flaps, though infection rates were similar. Smoking, diabetes and previous radiotherapy increase these risks. Ask your surgeon where the scar will sit, how it may look, and whether the plan risks pulling on nearby features such as the eyelid or lip.

Published figures to discuss

Complication rates vary with the size and site of the defect, the method used, and patient factors such as smoking, diabetes and previous radiotherapy. Comparative figures below come from a large single-centre study and are a guide rather than a personal prediction; your surgeon can give defect-specific advice.

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

Recovery — what to expect, and when

Recovery depends on the size of the reconstruction. Smaller repairs settle over a week or two, while major or free-flap surgery needs a hospital stay and a longer recovery. In all cases, the scar and final contour keep maturing for many months.

• Swelling and bruising that look worse before they look better
• Pink, firm scars that gradually soften and fade
• Numbness or odd sensation around the wound that often improves over months
• Mild tightness as a flap or graft settles
• A graft that looks patchy or different at first and blends over time

Aftercare

• Keep the wound clean and dry and follow your surgeon's specific dressing instructions.
• Keep your head raised in the first days to reduce swelling.
• Avoid smoking, which threatens flap and graft healing.
• Protect the area and scar from the sun with high-factor sunscreen once healed.
• Avoid strenuous activity, bending and heavy lifting in the early weeks.
• Follow advice on washing, shaving and make-up over the area.
• Keep follow-up appointments so healing and, where relevant, cancer follow-up are checked.
• Use scar massage or silicone if your team recommends it.

• Dressing supplies and written wound-care instructions
• High-factor sunscreen for the healed scar
• Time off work arranged (longer for major reconstruction)
• Someone to drive you home, especially after sedation or general anaesthetic
• Soft foods ready if the repair is near the mouth
• Clinic's contact number for problems saved
• Follow-up and any cancer-review appointments noted

Scars and how they heal

Facial reconstruction always leaves a scar, and there may be a second scar where a graft or flap was taken. Surgeons plan cuts to follow natural skin creases and the borders between facial areas so scars are as discreet as possible. Scars are pink and firm at first and usually soften and fade over six to twelve months. Sun protection, and sometimes scar massage or silicone gel, help them settle. Some scars, or a graft that differs in colour, remain visible.

⚠ Get urgent help if…

• A flap or graft turning pale, dusky, blue or very dark (a blood-supply problem — seek help urgently)
• Spreading redness, heat, swelling or discharge (signs of infection)
• Bleeding that will not stop, or rapid swelling under the skin
• Severe or increasing pain not eased by your usual painkillers
• A fever or feeling generally unwell after surgery
• If near the eye: any change in vision, severe eye pain or inability to close the eye

Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your surgeon gives you.

Results & realistic expectations

A good result restores a natural-looking facial contour and keeps nearby features — eyelid, lip, nostril — working properly, with scars that settle into natural lines. Smaller repairs often look very good once healed; complex reconstructions aim for the best achievable result rather than a perfect match. Final appearance takes months to mature as swelling resolves and scars fade. Where reconstruction follows cancer, a good cosmetic result does not affect the separate question of whether the cancer has been fully cleared, which is monitored in its own right.

Once healed, a facial reconstruction is generally a lasting repair. Scars continue to fade for up to a year or two and usually become less noticeable. The face still ages naturally afterwards, and a reconstructed area may age slightly differently from the surrounding skin. Where the surgery treated a skin cancer, long-term skin surveillance is important because new or recurrent skin cancers can develop.

Combining with other procedures

Facial reconstruction is often done immediately after, or shortly following, removal of a skin cancer (sometimes after Mohs surgery confirms clear margins). Complex repairs may be staged over more than one operation. Reconstruction near the eye, nose or lip may involve specialist surgeons working together, and small refinements are sometimes planned for a later date once healing has settled.

Follow-up & long-term care

You will be seen for wound checks and stitch removal in the first week or two, with later reviews as scars and contour mature. After free-flap surgery, early monitoring of the flap is intensive. Where the surgery treated a cancer, you will also have separate cancer follow-up and skin checks. Any plan for a small revision is usually discussed once healing has settled.

• Protect scars and reconstructed skin from the sun long-term
• Attend skin-cancer surveillance if the surgery treated a cancer
• Use scar treatments such as silicone or massage if advised
• Report any new lump, sore or change in the area promptly

Revision and secondary surgery reality

• A second, smaller operation to refine a scar or contour is sometimes planned once healing settles.
• A partly failed graft may need redressing, healing by itself or repeat grafting.
• A flap that distorts a nearby feature (eyelid or lip) may need correction.
• Staged reconstructions (such as a forehead flap for the nose) involve more than one planned operation.

Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.

What good aftercare looks like

• Clear written wound-care and warning-sign instructions, including flap blood-supply signs, with a named contact.
• Early wound checks and timely stitch removal to limit marks.
• A plan for scar care and, where relevant, skin-cancer surveillance.
• An agreed point at which any revision will be considered once healing settles.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

• The surgeon's fee and the complexity of the defect and method (direct closure, local flap, graft or free flap)
• Anaesthetic or sedation and the theatre or facility fee
• Whether a longer inpatient stay is needed (for example after a free flap)
• Specialist input, such as Mohs skin-cancer surgery or an oculoplastic surgeon for eyelid work
• Pathology and margin assessment where a cancer is involved
• Follow-up appointments and any planned revision surgery

• The surgeon's fee and the facility/theatre fee
• Anaesthetic or sedation fee
• Any inpatient stay for larger reconstruction
• Pathology/margin assessment costs if a cancer is involved
• Follow-up appointments and dressings
• Whether revision surgery is included if needed, and its cost
• The cancellation policy and what is covered if a complication occurs

On the NHS? Reconstruction after skin cancer, injury or for a congenital difference is normally NHS care; private access may be used for speed or choice of surgeon, while purely cosmetic refinement may not be funded.

You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

Consent traps and marketing red flags

These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.

Choosing a surgeon safely

• Check your surgeon is on the GMC Specialist Register for this area.
• Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
• You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
• Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
• You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

How Vuemedics verifies every consultant →

Take this to your consultation. A good surgeon will welcome every one of these.

• What does my defect involve, and which reconstruction method do you recommend and why?
• Where will the scar sit, and where would any graft or flap be taken from?
• Is there a risk of pulling on my eyelid, lip or nostril, and how will you avoid it?
• How likely is a graft or flap to partly fail, and what would happen then?
• Might I need a second or revision operation, and when would that be decided?
• If this follows a cancer, how and when will the margins and follow-up be handled?
• Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
• Will you be the surgeon who carries out my operation, and who looks after me afterwards?
• What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
• What does a realistic result look like — and what can this operation not achieve?
• What are my options, including waiting, doing nothing for now, or choosing a different approach?
• Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
• What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Find a verified surgeon for facial reconstruction

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How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: NHS — Skin cancer (non-melanoma) treatment British Association of Dermatologists — patient information leaflets Risk stratification of local flaps vs skin grafting in facial reconstruction (607 patients) — PMC Facial reconstruction for Mohs defect repairs — StatPearls, NCBI

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.