Dr Nathan Schaefer

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Brisbane, QLD
Dr Nathan Schaefer

Queensland-trained Plastic and Reconstructive Surgeon specialising in skin cancer excision and reconstruction

29/04/2026

What would you do for this case?

I almost always use an ipsilateral V-Y flap for nasal tip BCCs.

This time I couldn't.

This patient had a BCC on her left nasal tip — but a pre-existing scar blocked me from using a V-Y flap from that side.

So I used a contralateral V-Y flap instead, made possible by the rich blood supply from the superior alar artery.

Top row: day of surgery.
Bottom row: 18 months later.

Swipe 👉🏻 to see the scar that changed my approach.
Swipe 👉🏻 again for day 4 post-op (sutures out).

Want more on nasal reconstruction? Skin School — my free email newsletter for doctors — covers cases like this every week.

Link in bio.

22/04/2026

How I decide: graft or flap on the helix.
Final result at 12 months.

BCC on the superior helix.

After excision, I used a full thickness skin graft from the post-auricular area.

Why I chose a graft:
👉🏻 If cartilage intact → graft.
👉🏻 If cartilage removed → consider Antia-Buch flap.

Limitation of Antia-Buch here:
👉🏻 Less mobility from the helical root → higher risk of distortion.

If you cut out skin cancers and want practical case breakdowns like this, join my free email newsletter Skin School.

Link in bio.

15/04/2026

This patient had a Level 1 melanoma on her right temple.

After excision, I reconstructed the defect with a local flap.

Top row - day of surgery
Bottom row - 18 months later

This type of repair often tightens that side of the face early, so some asymmetry is expected. It usually settles over a few weeks (see the bottom row).

👉🏻 Swipe right to see the size of the skin cancer (blue) and the amount of skin removed (red).

If you’re doing skin cancer surgery and want practical case breakdowns like this, join my free email newsletter Skin School.

Link in bio.

08/04/2026

This was a tough case.

Young patient. Central forehead melanoma.

Once I took a 1 cm margin, I was left with a large central defect.

A graft would have been easier.

But on the forehead, grafts often stand out. Colour mismatch. Contour issues. Long-term it can be obvious.

So I chose bilateral advancement flaps.

Adjacent tissue. Better match. More predictable contour.

The trade-off is longer scars and more tissue movement required. But in this case, it was worth it.

Final photos are at 12 months.

📩 If you’re doing skin cancer surgery and like case breakdowns like this, sign up to my free email newsletter Skin School.

Link in bio.

01/04/2026

I would have grafted this a few years ago

Large infiltrative BCC on the nasal dorsum and sidewall
Referred for Mohs due to poorly defined borders

This is where the wrong reconstruction creates a visible long term problem

With the defect limited to the dorsum and sidewall, I chose a V-Y advancement flap

Why:
• Adjacent tissue = best match
• Maintains contour and subunit boundaries
• More predictable long term result

Final photos show before and 6 months after with maintained contour and symmetry

📩 If you want to improve your nasal reconstructions, I break down real cases like this every week in Skin School

Link in bio

25/03/2026

This patient had a squamous cell carcinoma on the nasal tip.

After excision (shaded area), the defect was reconstructed using a V-Y advancement flap.

Top row: Day of surgery
Bottom row: 12 months later

The nasal soft triangle is an unforgiving area. Even small errors can distort the contour.

If you don’t have much experience with local flaps here, a full thickness skin graft is often the safer option.

For more skin cancer surgery tips and case breakdowns, join my free weekly newsletter Skin School.

Link in bio.

18/03/2026

This patient had a large basal cell carcinoma on the right side of her chin. After excision, I reconstructed the defect using bilateral advancement flaps.

I also removed a small portion of skin beneath the lesion so one of the horizontal scars could sit along the jawline, where it is less visible.

👉🏻 Swipe right to see the size of the skin cancer (blue) and the amount of skin removed (red).

Top row - day of surgery
Bottom row - 16 months later

If you’d like to learn more about skin cancer surgery and reconstruction, you can join my free email newsletter via the link in my bio.

11/03/2026

This patient had an aggressive BCC on her right ear.

To ensure clear margins, I removed both the skin and the underlying cartilage. The ear was then reconstructed using an Antia-Buch flap.

👉🏻 Swipe right to see the 2-year result.

📩 I recently wrote a newsletter explaining when I remove cartilage for ear skin cancers — and when I don’t. Comment EAR and I’ll send it to you. You can also subscribe via the link in my bio.

04/03/2026

This patient had a BCC removed from beneath her nose. I reconstructed the defect using an A-T flap.

Top row: day of surgery
Bottom row: before and 12 months later

When the lesion sits below the nose but more lateral, I prefer an advancement/rotation-type flap so the scar can sit along the nasolabial fold (swipe right for an example 👉🏻).

📩 I recently wrote a newsletter about the challenges of upper lip reconstruction. Comment LIP and I’ll send it to you. You can also sign up via the link in my bio.

25/02/2026

This patient came to see me after having a skin cancer removed and reconstructed elsewhere. Unfortunately, that reconstruction later broke down, leaving a significant defect in the nose.

I rebuilt the area using a composite graft taken from the ear — including both skin and cartilage — and closed the donor site with a local transposition flap.

The opening photos show before surgery and seven weeks later.

👉🏻 Swipe right to see how it looked on the day of surgery.

If you enjoy surgical breakdowns like this, join my free weekly newsletter Skin School — link in bio.

10/02/2026

This patient had a BCC removed from the right lower eyelid. I reconstructed the defect using bilateral advancement flaps.

An alternative in this area is a laterally-based advancement flap, but this creates a long vertical scar on the lower eyelid (swipe right for an example 👉🏻).

Bilateral advancement flaps keep most of the scarring horizontal, matching the natural skin creases, and replace eyelid skin with eyelid skin for the best cosmetic result. A lateral advancement flap brings thicker cheek skin into the eyelid, so I reserve it for larger defects where bilateral flaps aren’t possible.

Top row: day of surgery
Bottom row: before and 14 months later

For more skin-cancer surgery tips and case breakdowns, join my free weekly newsletter Skin School — link in bio.

22/01/2026

This patient had two basal cell carcinomas.

👉🏻 The lesion next to the nose allowed me to hide the scar along the nasolabial fold.
👉🏻 The lesion near the eye required a full thickness skin graft.

In younger patients, I often use post-auricular skin as the donor site. It’s thin and similar to medial canthus skin. But the colour match is not ideal because it gets less sun exposure.

In older patients, I prefer upper eyelid skin. It’s the best match for colour and thickness, and the donor scar usually becomes very hard to see over time.

Top row: day of surgery
Bottom row: 10 months later

📩 I recently wrote a newsletter on the two most common reasons skin grafts fail. Comment GRAFT and I’ll send it to you. You can also sign up via the link in my bio.

Address

149 Wickham Terrace, Spring Hill
Brisbane, QLD
4000

Website

https://drnathanschaefer.com.au/

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