Dr Nathan Schaefer

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Australia
Brisbane, QLD
Dr Nathan Schaefer

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

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

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.

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.

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.

04/03/2026

This patient had a BCC removed from beneath her nose. I reconstructed the defect using an A-T flap.

Top row: day of surgery
Bottom row: before and 12 months later

When the lesion sits below the nose but more lateral, I prefer an advancement/rotation-type flap so the scar can sit along the nasolabial fold (swipe right for an example 👉🏻).

📩 I recently wrote a newsletter about the challenges of upper lip reconstruction. Comment LIP and I’ll send it to you. You can also sign up via the link in my bio.

25/02/2026

This patient came to see me after having a skin cancer removed and reconstructed elsewhere. Unfortunately, that reconstruction later broke down, leaving a significant defect in the nose.

I rebuilt the area using a composite graft taken from the ear — including both skin and cartilage — and closed the donor site with a local transposition flap.

The opening photos show before surgery and seven weeks later.

👉🏻 Swipe right to see how it looked on the day of surgery.

If you enjoy surgical breakdowns like this, join my free weekly newsletter Skin School — link in bio.

10/02/2026

This patient had a BCC removed from the right lower eyelid. I reconstructed the defect using bilateral advancement flaps.

An alternative in this area is a laterally-based advancement flap, but this creates a long vertical scar on the lower eyelid (swipe right for an example 👉🏻).

Bilateral advancement flaps keep most of the scarring horizontal, matching the natural skin creases, and replace eyelid skin with eyelid skin for the best cosmetic result. A lateral advancement flap brings thicker cheek skin into the eyelid, so I reserve it for larger defects where bilateral flaps aren’t possible.

Top row: day of surgery
Bottom row: before and 14 months later

For more skin-cancer surgery tips and case breakdowns, join my free weekly newsletter Skin School — link in bio.

22/01/2026

This patient had two basal cell carcinomas.

👉🏻 The lesion next to the nose allowed me to hide the scar along the nasolabial fold.
👉🏻 The lesion near the eye required a full thickness skin graft.

In younger patients, I often use post-auricular skin as the donor site. It’s thin and similar to medial canthus skin. But the colour match is not ideal because it gets less sun exposure.

In older patients, I prefer upper eyelid skin. It’s the best match for colour and thickness, and the donor scar usually becomes very hard to see over time.

Top row: day of surgery
Bottom row: 10 months later

📩 I recently wrote a newsletter on the two most common reasons skin grafts fail. Comment GRAFT and I’ll send it to you. You can also sign up via the link in my bio.

16/01/2026

This young patient had a squamous cell carcinoma on his nasal dorsum.�After excision (shaded area), I reconstructed the defect with a V-Y advancement flap.

Top row: day of surgery
Bottom row: 17 months later

The other option I commonly use here is a bilobed flap. If a pre-existing scar along the nasal sidewall limits V-Y movement, I’ll use a bilobed flap instead.

For more skin-cancer surgery tips and case breakdowns, join my free weekly newsletter Skin School — link in bio.

09/01/2026

This young patient had a large keloid scar on her right ear. This developed after getting her ear pierced. It failed to respond to intralesional steroids. I excised the keloid scar and used a full thickness skin graft to reconstruct the area.

The AFTER photo was taken at fourteen months post-op.

If you want to learn more about skin surgery you can join my free email newsletter - link in bio.

30/12/2025

This patient had a basal cell carcinoma above her left eyebrow. After excision, I reconstructed the defect using bilateral advancement flaps.

Top row - day of surgery.
Bottom row - before and 14 months after surgery.

👉🏻 Swipe right to see how much skin was removed (shaded red).

This area is often reconstructed with an A–T flap, but I usually avoid it because it creates a long vertical forehead scar. The natural anatomy here runs horizontally - the eyebrow, forehead creases, and hairline. Bilateral advancement flaps allow the scars to follow these horizontal lines, where they’re better concealed, especially within existing forehead creases.

15/12/2025

This patient had a large basal cell carcinoma on the tip of her nose. After removing it, I reconstructed the defect with a V-Y advancement flap.

👉🏻 Swipe right to see how much skin was removed (shaded red).

Top row: day of surgery.
Bottom row: 14 months later.

When the defect is this large, it’s tempting to use a full thickness skin graft instead. But a local flap almost always gives a better cosmetic result.

Address

149 Wickham Terrace, Spring Hill
Brisbane, QLD
4000

Website

https://drnathanschaefer.com.au/

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