Dr Nathan Schaefer

Home
Australia
Brisbane, QLD
Dr Nathan Schaefer

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

30/09/2026

Two problems with this graft - the colour, and the contour.

Years ago this lovely patient had a lesion taken off her nasal dorsum. It was repaired with a full thickness graft elsewhere. The colour didn’t match, and there was a concave deformity - more obvious on the lateral view.

Fixing that needed two things - better colour, and bulk. A forehead flap was the only option.

The complication was her forehead. She'd had several previous surgeries up there, including a large full thickness graft on the right. Not much spare real estate. But there was enough to work around the scars, excise the old graft, and bring forehead skin down onto her nose.

👉🏻 Swipe right to see the photos taken on the day of surgery.

The flap stayed connected for two weeks while it established a new blood supply from the nose. Then I could divide the connection between the forehead and the nose. I also took the opportunity to remove some of the forehead skin graft.

📸 Top row: before surgery
📸 Bottom row: 4 months later

📩 I recently wrote a newsletter where I break this case down in more detail and discuss the five advantages of the forehead flap. Comment FLAP and I’ll send it to you. You can also sign up via the link in my bio.

23/09/2026

A recurrent BCC on the left cheek - and a defect sitting right up against the lower eyelid.

After excision with Mohs surgery, I reconstructed this defect with a cheek rotation flap.

I've recently changed how I design these.

👉🏻 Swipe to see the triangle of skin I now remove medially (shaded yellow). Taking it from there puts more of the scar parallel with the nasal sidewall, which I think adds to scar camouflage.

It's also important to make sure that there is no dog ear laterally. This causes some wrinkling of the skin above the scar early on (top right photo). But this settles with time whilst a dog ear doesn’t.

📸 Top row: day of surgery
📸 Bottom row: 23 months later

📫 Join Skin School - my free newsletter for doctors doing skin cancer surgery. Link in bio.

16/09/2026

A full thickness nasal rim defect - and a forehead I couldn't use.

This patient was referred to me with an infiltrative BCC over her soft triangle (top left).

The soft triangle is unforgiving, so I wanted the excision as tissue-preserving as possible and sent her to my local Mohs surgeon.

📸 Top right - the defect he left me.

My go-to for a full thickness rim defect is a paramedian forehead flap. But this wasn't her first skin cancer. Her forehead was short and covered in scars.

So I used a melolabial interpolation flap instead, folded in on itself to recreate the rim and the lining (bottom left).

The flap stayed connected for two weeks while it established a new blood supply from the nose. Then I could divide the connection between the cheek and the nose.

👉🏻 Swipe right to see the end result.

📫 I recently wrote a newsletter where I break this case down in more detail and discuss the advantages of the melolabial flap. Comment NOSE and I’ll send it to you. You can also sign up via the link in my bio.

09/09/2026

Two biopsies came back as nodular BCC. Her nose said otherwise.

This patient was referred with two biopsy-confirmed nodular BCCs on her nasal tip. It didn't look nodular to me, so I sent her for Mohs rather than excising it myself. The top left photo shows you the defect I was sent.

A graft is tempting on a defect like this. But a V-Y advancement flap beats a graft on colour and contour every time.

The alar component was the exception. Advancing the flap into it would have pulled on the nostril margin, so I used a small full thickness graft from the tail of the flap. No second donor site, no rim distortion, and the nasal ala crease stays intact.

➡️ On the nose, protect the alar rim and crease first. That's where symmetry lives, and it's the first thing your patient looks for in the mirror.

📫 I break down cases like this every week in Skin School, my free newsletter for doctors doing skin cancer surgery. Link in bio to sign up.

📸 Top row — day of surgery
📸 Bottom row — before and 18 months later

02/09/2026

Some skin cancers are harder to cut out than others.

This patient's infiltrating BCC was excised elsewhere and closed with a local flap.

Histology showed involved peripheral and deep margins. Because a local flap had been used, working out which margin was positive would have been guesswork.

So I sent her for Mohs. The top left is the defect once clearance was achieved.

I closed it with a cheek rotation flap, hiding as much scar as I could in the nasolabial fold and marionette line.

A small full thickness graft above the lip kept that area from being pulled out of position.

When the subtype carries a higher risk of a positive margin ➡️ refer for Mohs or hold off on a flap repair until you know you're clear.

📫 Join Skin School — my free newsletter for doctors doing skin cancer surgery. Link in bio.

📸 Top row — day of surgery
📸 Bottom row — before and 12 months later

26/08/2026

An aggressive BCC on the forehead of a young patient - in a spot where any scar is on show.

Mohs cleared the tumour and I reconstructed it with bilateral advancement flaps.

📸 Top row: day of surgery
📸 Bottom row: before and 11 months later

Most of the lines of the upper face run horizontally - the hairline, the forehead creases, the brows. Bilateral advancement flaps keep the majority of the scars horizontal as well, so they don't attract the eye.

The mistake I used to make with these is having these horizontal scars too short, as this prevents them from sitting completely flat. Longer scars which sit completely flat are harder to see.

📫 Join Skin School - my free newsletter for doctors doing skin cancer surgery. Link in bio.

30/06/2026

This young patient had cancers cleared by Mohs on her nasal sidewall and upper forehead, then came to me for the reconstruction.

I used a V-Y flap for the nose, and I was able to close the forehead directly.

📸 Top row — day of surgery
📸 Bottom row — before and 13 months later

👉🏻 Swipe to see my markings

📫 Join Skin School — my free newsletter for doctors doing skin cancer surgery. Link in bio.

23/06/2026

I always try and keep scars off the cheek if I can.

This patient presented with a BCC on her lower eyelid and medial cheek, cleared by Mohs and sent to me for reconstruction.

I closed it with a cheek rotation flap. That let me hide the scars along the nasolabial fold and nasal sidewall, just under the lash line, and laterally into a crow's foot. This keeps everything off the cheek, where scars are far more noticeable (see my post from two weeks ago).

There was also a small medial canthal component, so I added a full thickness skin graft using the skin removed next to the nasolabial fold.

📸 Top row — day of surgery
📸 Bottom row — before and 14 months later

I wrote a Skin School article recently on when I refer patients for Mohs surgery. Comment “MOHS” and I'll send it your way.

📫 Join Skin School — my free newsletter for doctors doing skin cancer surgery. Link in bio.

16/06/2026

The upper cutaneous lip is one of the hardest areas on the face to reconstruct.

This patient presented with a poorly-defined BCC on his right upper cutaneous lip. This was removed via Mohs surgery, which left a sizeable defect.

I went with a V-Y advancement flap here. The advantage is scar placement. You can often hide scars along the vermilion border and down into the marionette line. Sometimes even the vertical scar sits right on the philtral column.

📸 Top row — day of surgery
📸 Bottom row — before and 15 months later

I wrote a Skin School article recently on exactly this: why the upper lip is so unforgiving and how to approach it. Comment “UPPER” and I'll send it your way.

📫 Join Skin School — my free newsletter for doctors doing skin cancer surgery. Link in bio.

10/06/2026

This graft wasn't working. Here's what I did instead.

Pale colour match. Uneven contour. Hard to hide with makeup.

This patient had a full thickness skin graft to her medial canthus after skin cancer excision (performed elsewhere). She preferred it to be less noticeable.

So I removed the graft (shaded area) and reconstructed with a V-Y advancement flap.

📸 Top row — day of surgery
📸 Bottom row — before and 18 months later

The medial canthus is an unforgiving location — the skin is thin, the contour is complex, and a poor colour match is obvious at conversational distance.

📩 I recently wrote a newsletter on how I choose between a graft and a flap in this area. Comment CANTHUS 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/

Alerts

Be the first to know and let us send you an email when Dr Nathan Schaefer posts news and promotions. Your email address will not be used for any other purpose, and you can unsubscribe at any time.

Contact The Practice

Send a message to Dr Nathan Schaefer:

Help for You - Rosemary Brown

Want your practice to be the top-listed clinic in Brisbane?