tension on the flap, a misidentification of past injury, nearby scar formation, fanatic inset to the recipient site or exaggerated flap thinning. To solve the problem, to keep the underlying cartilage from infecting and to stop the situation from getting worse, it is better to excise dead tissue at an early stage than to wait watchfully allowing the injury to heal secondarily Infection It is unlikely for the operation area to get infected. In this situation failure in aseptic techniques or necrosis of the lining are the main causes. Early discovery of infection is very important so complete debridement can take place before underlying cartilage is exposed. Chronically infected cartilage is cured by reelevating the flap and excising the infected parts. Recurrence/ inadequate initial reconstruction In some patients a new tumor develops in the skin injured by the sun or an old cancer can redevelop. In a few cases the result of the first reconstruction was not good enough. When this takes place the next step is to take away the old flap and redo the reconstruction. A second flap can be taken from the contra lateral side in most instances Eyebrow malposition The defect created at the donor site is usually positioned at the central/lateral forehead. The defect can be closed by pulling the different sides of the wound together in vertical and horizontal direction. If there is a resulting defect after closure it is situated high in the forehead and it closes by secondary healing. In spite of the fact that, as a result, the eyebrow could be distorted, this is usually avoided. As a result of a large initial defect, the flap has to be larger and the bigger the forehead defect will be. When there is a large resultant forehead defect it logically lies closer to the eyebrow. That is why there is a significant risk of superior eyebrow malposition, especially if a horizontal or oblique oriented forehead flap is used. Then the solution is to close the remaining defect with a skin graft. However a skin graft is esthetically inferior and will always look like a shiny, irregularly pigmented, mismatched piece of skin. Alternatively, secondary placement of a tissue expander in the forehead can be used to correct the eyebrow malposition and to excise the skin graft and primarily close the forehead defect. See also References Plastic surgery Nose surgery Facial features