Dr Nathan Schaefer

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

Skin SchoolA free weekly email on skin cancer surgery.Written by Plastic & Reconstructive Surgeon Dr Nathan Schaefer.Rea...
20/05/2026

Skin School

A free weekly email on skin cancer surgery.

Written by Plastic & Reconstructive Surgeon Dr Nathan Schaefer.

Read by over 5,000 GPs, dermatologists, and surgeons.

Sign up via the link in bio.

Reconstructing the lower eyelid? The flap you choose makes or breaks the long-term result.This patient had a BCC removed...
13/05/2026

Reconstructing the lower eyelid? The flap you choose makes or breaks the long-term result.

This patient had a BCC removed from the lower lid, and I reconstructed the defect with a laterally-based advancement flap.

For smaller defects in this area though, I'll usually reach for bilateral advancement flaps instead (swipe for an example 👉🏻).

Here's the thinking: bilateral flaps keep most of the scarring horizontal — matching the natural skin creases — and replace eyelid skin with eyelid skin. Hard to beat that cosmetically.

A lateral advancement flap brings thicker cheek skin into the eyelid, so I save it for larger defects where bilateral flaps just aren't an option.

Top row: day of surgery Bottom row: before and 18 months later

Want more case breakdowns like this one? Join Skin School, my free weekly newsletter for skin cancer doctors — link in bio.

Not many options when a skin cancer sits just below the eyebrow.Here's how I approached this one:❌ Vertical excision - s...
06/05/2026

Not many options when a skin cancer sits just below the eyebrow.

Here's how I approached this one:
❌ Vertical excision - shortens the eyebrow
❌ Horizontal excision - not enough upper eyelid excess so this would cause asymmetry
❌ Graft - poor cosmesis due to colour and thickness mismatch

✅ Bilateral advancement flaps

Why it works:
Scars stay horizontal
Matches the eyelid creases + brow line

Top row: day of surgery
Bottom row: before and 16 months later

👉🏻 Swipe right to see how it presented

For more case breakdowns like this, join Skin School — my free weekly newsletter. Link in bio.

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.Thi...
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.

How I decide: graft or flap on the helix.Final result at 12 months.BCC on the superior helix.After excision, I used a fu...
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.

This patient had a Level 1 melanoma on her right temple.After excision, I reconstructed the defect with a local flap.Top...
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.

This was a tough case.Young patient. Central forehead melanoma.Once I took a 1 cm margin, I was left with a large centra...
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.

I would have grafted this a few years agoLarge infiltrative BCC on the nasal dorsum and sidewallReferred for Mohs due to...
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

This patient had a squamous cell carcinoma on the nasal tip.After excision (shaded area), the defect was reconstructed u...
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.

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

This patient had an aggressive BCC on her right ear.To ensure clear margins, I removed both the skin and the underlying ...
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.

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149 Wickham Terrace, Spring Hill
Brisbane, QLD
4000

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