From the Research
The glabellar superciliary bilobed flap is the best option for skin cancer excision over the glabella, as it provides excellent cosmesis and is associated with minimal complications, as demonstrated in a recent study 1. This flap utilizes adjacent tissue from the forehead to reconstruct the defect while maintaining good aesthetic outcomes. The bilobed design allows for effective closure of the primary defect while distributing tension across multiple tissue planes, which is particularly important in the glabella region where skin is less mobile and directly overlies bone. When performing this procedure, careful planning of the flap is essential, with the primary lobe typically designed to be about 90-100% of the defect size and the secondary lobe slightly smaller. The flap should be elevated in the subcutaneous plane to preserve blood supply. Some of the key benefits of this flap include:
- Excellent cosmesis, with highly satisfactory aesthetic outcomes for both surgeons and patients 1
- Minimal complications, with no intraoperative complications reported in a series of 30 patients 1
- Effective closure of the primary defect, with primary closure of the donor site achieved in all cases without wound dehiscence 1 Alternative options, such as paramedian forehead flaps for larger defects or advancement flaps, may be considered, but the glabellar superciliary bilobed flap often provides superior cosmetic results with minimal distortion of surrounding anatomical landmarks like eyebrows. The glabellar region's unique position between the eyebrows makes reconstruction challenging, and the glabellar superciliary bilobed flap addresses this by recruiting tissue with similar color, texture, and thickness while minimizing donor site morbidity. Other studies have also demonstrated the effectiveness of bilobed flaps in skin cancer reconstruction, including a study of 285 patients with basal cell carcinomas or squamous cell carcinomas, which reported completely acceptable aesthetic and functional results in 96.4% of patients 2. However, the most recent and highest-quality study, published in 2022, supports the use of the glabellar superciliary bilobed flap for reconstruction of large medial canthus region defects, making it the recommended choice for skin cancer excision over the glabella 1.