Excision of facial lesions frequently leaves a circular or elliptical defect. If the skin is loose and can be approximated without deformity of the surrounding tissue, that is the treatment of choice. The use of a V-Y advancement flap eliminates secondary procedures to revise dog-ears that occur with rotation flaps.

In our patients, the most common of the V-Y flaps are the nasal dorsal flap to cover defects on the nasal dorsum or ala and nasolabial flaps to cover defects of the ala or alar base. The flaps also have been found to be excellent to close defects of the nasal tip and eyelid. They have been used in numerous areas on the face (Fig. 97.1).

We found that large defects of the lower eyelid skin can be closed with a V-Y flap from the cheek without ectropion. V-Y glabellar advancement flaps are excellent for closure of wounds of the medial canthal area. V-Y flaps are also excellent for closure of forehead defects, where the flap can be advanced in the transverse wrinkle lines of the forehead. We found this flap to be especially good in the area of the sideburn in men, where one flap can be brought up from the beard area and another down from the temple area, which reconstructs the sideburn (Fig. 97.3).