Stepwise, Multi-Incisional, and Single-Stage Approach to Reshape Facial Contour After Large Cutaneous Lesion Resection

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Removal of large facial benign cutaneous lesions remains challenging. Serial or complete excisions together with local flaps or expander-based reconstructions are required. However, those techniques are time-consuming and may contribute to poor cosmetic and functional outcomes.


The authors describe the resection and reconstruction of large facial benign cutaneous lesions by using Stepwise, Multi-Incisional, and Single-Stage (SMISS) approach.


The authors performed a retrospective review from all patients with large facial benign cutaneous lesions who underwent “SMISS” approach for reconstruction between September 2013 and December 2014.


The authors treated 47 patients (32 female and 15 male; mean age 23.5 years, range 9–50 years). Follow-up was for 12 months or longer. The mean length of major axis was 43.91 mm, minor axis 32.10 mm, and scar 66.91 mm. Good to excellent outcomes were achieved in all patients with a mean Vancouver scar scale score of 3.46 ± 0.39 (Cronbach α = 0.890) and mean visual analog scale score of 8.02 ± 0.69 (Cronbach α = 0.946).


This was a nonrandomized, unblinded clinical case series with a limited sample size.


For the excision and reconstruction of large facial benign cutaneous lesions, “SMISS” technique can be considered as a suitable option, leading to excellent results and a high patient satisfaction.

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