This gentleman holds the record for the most procedures I’ve performed on any one individual. He is in his 70’s and tends to form aggressive skin cancers. Here he has developed three rapidly growing lesions on his nose. We removed them all at the same time, which left a defect that encompassed most of the skin of the lower part of his nose. Most of the time with small defects of the nose, we can rotate skin from other parts of the nose to close the hole. We were out of luck here. Instead, we did a paramedian forehead flap. Paramedian forehead flaps are based off of arteries that run vertically from your eye socket to your hair line. A portion of forehead skin containing this artery is raised and transferred to the nose. The artery is left intact so the skin receives oxygen and nutrients while new blood vessels enter from the leftover skin of the nose. After about three weeks, the bridge of skin containing the artery is removed and the patient looks a lot more normal! The post-operative pictures were taken about six weeks following his second operation. His nose looks normal, and the forehead scar is imperceptible.