A glabellar flap procedure is a reconstructive surgical technique that uses tissue from the glabella, the area between the eyebrows and above the nose, to repair defects on the face. This method is employed to restore areas where skin has been removed due to trauma, tumor excision, or other conditions. The purpose of this procedure is to provide a good color and thickness match to the surrounding facial skin, aiming for optimal aesthetic and functional outcomes.
Understanding the Glabellar Flap
The glabellar flap originates from the glabella, the smooth skin area between the eyebrows and superior to the nasal bridge. This region is characterized by skin that is thicker and more redundant compared to other facial areas, making it a suitable donor site for reconstructive surgery. The skin in the glabellar area offers a favorable color and texture match for defects on the nose and medial canthus, the inner corner of the eye.
The blood supply to the glabellar flap is derived primarily from the supratrochlear and supraorbital arteries, which are branches of the ophthalmic artery. These vessels ensure the flap’s viability when moved to the recipient site. The underlying muscles in this area include the procerus, frontalis, and corrugator supercilii, which are involved in facial expressions but are carefully managed during flap elevation.
Applications of the Glabellar Flap
The glabellar flap is a versatile local flap used for reconstructing skin defects, primarily on the nose and particularly in the medial canthal area. It is frequently utilized following the excision of skin cancers, such as basal cell carcinoma. The flap’s proximity to these areas and similar skin characteristics make it a good choice for repair.
This flap is especially well-suited for defects located on the upper and middle thirds of the nasal dorsum, as well as the nasal tip. It can address defects involving the ala (the rounded outer part of the nostril) or columella (the tissue between the nostrils). The ability to provide tissue with matching color, texture, and thickness helps achieve seamless reconstruction.
The Glabellar Flap Surgical Procedure
The surgical procedure for a glabellar flap begins with careful preoperative planning, which includes assessing the size, depth, and location of the defect. The surgeon designs the flap, often as a V-Y advancement or transposition flap, marking incision lines on the skin. The flap’s width is typically designed to match the defect, while its length may be longer to account for tissue movement.
An incision is made through the skin and subcutaneous fat, and the flap is carefully lifted, ensuring its blood supply remains intact. The underlying tissue in the donor area is often undermined to allow for easier closure. The flap is then rotated or advanced into the defect, and its ability to cover the area without tension is checked.
Once positioned, the flap is secured with sutures, often using dissolvable sutures beneath the skin and fine sutures on the surface. The donor site in the glabella is then closed, typically in a V-Y fashion, which may result in a slight narrowing of the interbrow distance. The distal portion of the flap may be thinned to better match the recipient site’s skin thickness, while the proximal part is kept thicker to preserve blood supply.
Post-Surgical Recovery and Expectations
Following a glabellar flap procedure, patients can expect some swelling, bruising, and mild to moderate discomfort in the surgical area. Pain is typically manageable with oral medications and should begin to decrease within 48 hours. Initial healing of the incisions usually occurs within 7 to 10 days, at which point external stitches may be removed.
The appearance of the reconstructed area will improve over time, with initial redness and elevation of the incision gradually fading. While significant healing occurs within the first few weeks to months, full maturation of the flap and scar can take up to a year. Applying sunscreen to the incision for at least six months after surgery is recommended to protect the healing skin.