Facial Reconstructive Surgery

MOHS Reconstructive Surgery

Birth Defect Surgery, and Trauma Surgery

At the New York Center for Facial Plastic and Laser Surgery, Andrew Jacono, M.D.
performs Reconstructive Facial Surgery to help individuals overcome physical limitations 
placed on them by circumstances beyond their control – facial deformities at birth, 
deformities due to cancer of the head and neck, and facial anomalies due to trauma.  
Doctor Jacono is part of Face to Face (Click here to learn more) and is one of a small 
group of Facial Plastic and Reconstructive Surgery Specialists who volunteer 
their time to perform Reconstructive Surgery on women who are victims of domestic
violence pro-bono.

Scar Revision Surgery 
Facial Paralysis Surgery
Dog Bites 
Skin Cancer Reconstruction/Mohs Reconstruction (See Below)

Mohs Reconstruction Surgery Patient 1.  Upper Lip Defect Reconstruction.  Patient 
underwent a bilateral transposition flap. borrowing cheek skin to reconstruct the upper lip.

MOHS Surgery

Mohs micrographic surgery (MMS) is a surgical technique in which minute layers of skin 
tissue are meticulously removed and examined under a microscope. By removing thin layers 
of tissue in this incremental manner, the physician can be sure that all involved tissue is excised, 
and can simultaneously spare healthy tissue. Of all the surgical techniques available today, 
Mohs surgery offers both the lowest recurrence rate of malignant lesions, and maximum 
preservation of healthy tissue.  Mohs surgery is performed by specialized Dermatologic 
Surgeons  who only perform skin cancer removal, and then refer patients for reconstruction 
to a Facial Plastic Surgeon such as Doctor Jacono.

Mohs surgery is more time consuming and expensive than traditional excision. However, its precision is especially valuable for recurrent or aggressive carcinomas, for treatment of cosmetically important areas such as the nose, eyelids and lips, and for high risk and invasive lesions (such as near a facial nerve). Mohs surgery is now frequently used to remove basal cell carcinomas, squamous cell carcinomas, and other lesions on the face.

After a malignant lesion is removed with Mohs surgery, a depression or hole in the skin remains. Such scars may be rather disfiguring, and reconstructive surgery may be performed immediately after Mohs surgery to repair the damaged site. Dr. Jacono specializes in carefully reconstructing the facial tissue in such patients, restoring their skin’s natural appearance

Mohs Reconstructive Surgery Patient 2.  Nasal Defect Reconstruction
with Multiple Staged Repair.  This defect required a two staged surgery using a 
pedicled (stays attached to the donor site) paramedian forehead flap.  The second 
stage involved sectioning the flap attachment.

Mohs Reconstruction Surgery Patient 3.  Nose and Eyelid Defect Reconstruction.
Nasal Defect Reconstruction with Multiple Staged Repair.  This defect required a two 
staged surgery using a pedicled (stays attached to the donor site) paramedian forehead flap.  
The inside of the nose was repaired with a septal flpa, and cartilage was borrowed from 
his ear.  The second stage involved sectioning the flap attachment.  Patient underwent a 
two staged pedicled (stays attached to the donor site) Hughes Flap 
Borrowing Cartilage and Skin from the upper eyelid.

Mohs Reconstruction Surgery Patient 4.  Cheek and Eyelid Defect Reconstruction.
Patient underwent a neck transposition flap, and forehead and cheek rotation flap to close 
this large defect.

After your Mohs surgery is complete your dermatologist will bandage the wound and send
you to Doctor Jacono's office. This can be done the day of surgery or the following day.
Once the bandage is removed and the defect is assessed, the proper reconstruction will be
chosen. Most defects can be repaired with skin flaps. A skin flap utilizes local redundant
tissue and advances or ‘flaps’ it over to cover the Mohs defect. When appropriate, when the
skin color and texture matches, a skin graft may be employed on certain parts of the face.
A skin graft involves removing a piece of skin from a donor site and then sewing it into the
Mohs defect. Donor sites are typically chosen from areas with excess skin in inconspicuous
locations, such as behind the ear. Care must be taken with skin grafts, because if
chosen to treat the wrong defect site, the repair can appear "patched" and unnatural.

Sometimes more complex or multiple staged reconstruction are required depending
upon how much tissue is removed and whether other tissue such as cartilage and
bone must be reconstructed and replaced. Doctor Jacono Specializes in these more
complex surgeries.

Whether you have a flap or a graft, evaluation for possible further refinement with
dermabrasion is performed at approximately the sixth post-operative week.

The photographs that follow are graphic, but help demonstrate how reconstructive
surgery can help restore normal facial appearance and function. They are actual
patients of Doctor Jacono's and have not been altered for presentation here.

Mohs Reconstruction Surgery Patient 5. Upper Lip Defect Reconstruction. Patient
underwent a bilateral transposition flap. borrowing cheek skin to reconstruct the upper lip.



Mohs Reconstruction Surgery Patient 6.  Nose and Eyelid Defect Reconstruction.
Patient underwent a glabellar (forehead) transposition flap and cheek advancement flap.

Mohs Reconstruction Surgery Patient 7. Forehead Defect Reconstruction. Patient underwent an Orotrichea Flap closure.

Mohs Reconstruction Surgery Patient 8. Forehead Defect Reconstruction. Patient underwent an O to T advancement flap, borrowing along the hairline.



Mohs Reconstructive Surgery Patient 10.  Nasal Defect Reconstruction
with Multiple Staged Repair.  This defect required a two staged surgery using a 
pedicled (stays attached to the donor site) paramedian forehead flap.  The second 
stage involved sectioning the flap attachment.


Mohs Reconstruction Surgery Patient 11.  Nose Defect Reconstruction.
This defect required a two staged surgery using a pedicled (stays attached to the
donor site) cheek flap and ear cartilage graft to reconstruct the natural curvature 
of the nasal rim.  The second stage involved sectioning the flap attachment.

Mohs Reconstructive Surgery Patient 12. Nasal Defect Reconstruction with Multiple Staged Repair. This defect required a two staged surgery using a pedicled (stays attached to the donor site) paramedian forehead flap. The second stage involved sectioning the flap attachment

Mohs Reconstructive Surgery Patient 13. Upper Lip Defect Reconstruction. A nasal crescenteric lip advancement flap was utilized to reconstruct this defect of the lip.

Mohs Reconstruction Surgery Patient 14. Cheek Defect Reconstruction. This patient had a cheek rotation flap for reconstruction in a single stage.


Mohs Reconstructive Surgery Patient  15.  Eyelid Defect Reconstruction.
A specialized flap called a tenzel flap was used to reconstruct the eyelid, and the 
lacrimal (tear duct) apparatus was reconstructed.  A Tenzel flap borrows from the 
cheek skin.

Mohs Reconstructive Surgery Patient 16. Lower Lip Defect Reconstruction. A vermillion lip advancement flap was utilized to reconstruct this defect of the lip.


Mohs Reconstructive Surgery Patient 17.  Nasal Defect Reconstruction
with Multiple Staged Repair.  This defect required a two staged surgery using a 
pedicled (stays attached to the donor site) paramedian forehead flap.  The second 
stage involved sectioning the flap attachment.

Mohs Reconstruction Surgery Patient 18. Forehead Defect Reconstruction. Patient underwent an O to T advancement flap, borrowing along the hairline.

Mohs Reconstructive Surgery Patient 19. Full Thickness Upper Lip Defect Reconstruction. A nasal cresenteric lip advancement flap was utilized to reconstruct this full thickness defect of the lip.

Mohs Reconstructive Surgery Patient 20. Eyelid Defect Reconstruction. A specialized flap called a tenzel flap was used to reconstruct the eyelid, and the lacrimal (tear duct) apparatus was reconstructed. A Tenzel flap borrows from the cheek skin.


Mohs Reconstruction Surgery Patient 21.  Cheek and Eyelid Defect Reconstruction.
Patient underwent a neck transposition flap, and forehead and cheek rotation flap to close 
this large defect.



Mohs Reconstructive Surgery Patient 22.  Nasal Defect Reconstruction.
A Glabellar Flap was used to close this nasal defect and prevent alar distortion.

Mohs Reconstructive Surgery Patient 23.  Nasal Alar Defect Reconstruction.  
This defect required a two staged surgery using a pedicled (stays attached to the
donor site) cheek flap and ear cartilage graft to reconstruct the natural curvature 
of the nasal rim.  The second stage involved sectioning the flap attachment.


Mohs Reconstructive Surgery Patient 24.  Eyelid Defect Reconstruction.
A specialized flap called a tenzel flap was used to reconstruct the eyelid, and the 
lacrimal (tear duct) apparatus was reconstructed.  A Tenzel flap borrows from the 
cheek skin.  A full thickness skin graft was also required.


Mohs Reconstructive Surgery Patient 25.  Full Thickness Upper Lip 
Defect Reconstruction.  A nasal cresenteric lip advancement flap was
utilized to reconstruct this full thickness defect of the lip.


Mohs Reconstructive Surgery Patient 26.  Nasal Defect Reconstruction
with Multiple Staged Repair.  This defect required a two staged surgery using a 
pedicled (stays attached to the donor site) paramedian forehead flap.  The second 
stage involved sectioning the flap attachment.

Mohs Reconstructive Surgery Patient 27.  Ear Defect Reconstruction.
A chondrocutaneous V to Y advancement flap with a full thickness skin 
graft was used to restore natural contour to this ear.

Mohs Reconstructive Surgery Patient 28.  Eyelid Defect Reconstruction.
A glabellar (forehead) transposition flap was used to close this eyelid defect.


Mohs Reconstructive Surgery Patient 29.  Nasal Tip Defect Reconstruction.
A bilobed flap was used to close this nasal defect and prevent alar distortion.


Mohs Reconstructive Surgery Patient 30.  Nasal Defect Reconstruction.
A single staged meloabial (cheek skin) transposition flap was used for reconstruction.