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Limits for the use of forehead flaps for small and extensive midface reconstructions including septum/columella reconstructions.

I describe six selected cases of challenging reconstructions in the midface including a small deepithelialised and tunnelled flap for volume-replacement and conjunctiva-reconstruction in the orbit and a case of septum/columella reconstruction with a tunnelled paramedian forehead flap. Big flaps for extensive complex reconstructions in the midface (cheek, lip, and nose) emphasis the efficiency of the flaps. In extensive reconstructions the paramedian forehead might primarily be used for lining. Indian forehead flaps should be dissected to the base in the upper eyelid to increase their strength and for greater versatility. The base can be de-epithelialised without threatening its viability. This procedure allows the flap to be tunnelled and increases the mobility of the flap. Long flaps can even be folded without delay.