Alar Notching and Retraction

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A 77-year-old-woman presented with a 0.3 cm × 0.3-cm notch on her left lateral alar rim (Figure 1). Eleven weeks prior, the patient underwent Mohs surgery on the left ala for a squamous cell carcinoma, producing a 1.7 cm × 1.5-cm defect extending to the fibrofatty tissue within several millimeters of the rim. Although an interpolation flap would have been ideal, the patient refused a staged reconstruction. A full-thickness skin graft was performed but failed postoperatively and resulted in a contracted, hypopigmented scar and a notched alar rim.
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