Patient-reported outcomes after nasal reconstruction: FACE-Q assessment across techniques from skin grafts to complex reconstructions

Nasal reconstruction after skin cancer excision represents one of the most demanding tasks in reconstructive surgery, aiming to restore function and aesthetics simultaneously. Although surgical techniques continue to evolve, limited data exist comparing patient-reported outcomes across different reconstructive approaches. This study used the FACE-Q Skin Cancer questionnaire, a validated patient-reported outcome measure (PROM), to assess satisfaction and psychosocial well-being among patients undergoing various nasal reconstructions. A retrospective single-center study was performed including patients who underwent nasal reconstruction after excision of melanoma and non-melanoma skin cancers between 2019 and 2022. Patient-reported outcomes were assessed using the FACE-Q Skin Cancer module administered at least one year postoperatively. Of 189 patients contacted, 120 met the inclusion criteria and were stratified according to the reconstructive technique into six groups: paramedian forehead flap, nasolabial flap, bilobed flap, Rieger/Marchac flap, frontoglabellar flap, and skin graft. Differences in FACE-Q scores among groups were analyzed using one-way ANOVA. All techniques yielded high satisfaction levels regarding scar appraisal, facial appearance, and quality-of-life domains. A statistically significant difference was observed for “Cancer Worry” (p = 0.008), with skin graft patients showing higher anxiety concerning recurrence. All reconstructive techniques provided satisfactory aesthetic and psychosocial outcomes. However, patients reconstructed with skin grafts reported higher cancer-related worry, possibly due to the patch-like appearance which may act as a visual reminder of the previous lesion. These findings highlight the importance of careful reconstructive planning and preoperative counselling. The use of PROMs such as FACE-Q enables a more comprehensive, patient-centered evaluation of nasal reconstruction outcomes. Level of evidence: Not gradable.