A guy who is 73 years old and has been diagnosed with a recurrence of skin squamous cell carcinoma that has spread to the nasal septum and dorsum and has metastasized to lymph nodes (cT4aN2bM0). Earlier, he had surgery at another facility for a partial rhinectomy as well as repair of the left ala with a left forehead flap.

The patient had a partial rhinectomy as well as bilateral neck dissection, which led to a diagnosis of pN3b, ENE +, and the sub-galeal placement of a tissue expander on the patient’s top right forehead (an uncommon location owing to the scars from prior surgery).Radiotherapy with adjuvant treatment was carried out on N. After a delay of six months after the conclusion of radiation on the neck, reconstruction was finally performed. During this time, the columella exhibited increasing deformation, progressively sloping to the left side of the head.