About the Procedure
A free graft is tissue that is completely detached from its original site and placed into a facial defect, where it relies on the surrounding tissue to supply blood and heal into place. Common types include skin grafts, cartilage grafts, and composite grafts that combine skin and cartilage, each chosen to match the missing tissue.
Facial free grafts are often used to repair defects after Mohs surgery or other skin cancer removal, traumatic wounds, or revision of earlier reconstruction. The aim is to restore skin coverage, contour, and structural support while keeping color, thickness, and texture as close to the surrounding face as possible.
At Norelle Health, the choice between a free graft, a local flap, or another reconstructive method is individualized. Evaluation considers the size and depth of the defect, its location, the quality of the surrounding skin, and the patient's healing and goals.
Types of free grafts
Several types are used on the face, depending on what tissue is missing:
- Skin grafts, taken as thin or full-thickness skin to resurface a defect
- Cartilage grafts, often from the ear or nasal septum, to rebuild structural support such as in the nose or eyelid
- Composite grafts, which include skin and cartilage together for areas like the rim of the nostril
The donor site is selected to match the color, thickness, and contour of the area being repaired.
Considering free grafts? The next step is a quiet, unhurried conversation.
Who may be a candidate
A free graft may be considered when a defect cannot be closed directly and a graft suits the location and tissue needs. It is commonly used after Mohs or other skin cancer removal, trauma, or revision of prior reconstruction.
Not every defect is best treated with a graft. Wound bed quality, circulation, smoking, and the need for structural support all influence whether a graft, a local flap, or staged repair is the better choice.
How it is performed
The defect is prepared, and a graft of the appropriate type and size is taken from the donor site. The graft is shaped to fit and secured in place, often with a bolster dressing that applies gentle pressure to help it adhere to the wound bed.
The procedure may be performed under local anesthesia with sedation or general anesthesia, depending on the size and location of the repair and patient factors.
Recovery and aftercare
The graft and donor site are dressed, and the bolster or dressing is typically left undisturbed for several days while the graft takes. Patients are asked to avoid pressure, strain, and excess movement at the site during early healing.
Mild swelling, color change, and crusting are expected. Wound care instructions, sun protection, and later scar care help the graft blend with surrounding skin over the following weeks to months.
Risks and alternatives
Possible risks include partial or complete graft loss, infection, bleeding, color or contour mismatch, and visible scarring at both the graft and donor sites. Smoking and poor circulation increase the risk of graft failure.
Alternatives include direct closure, local or regional flaps, free flaps for larger or deeper defects, or healing by secondary intention in selected wounds. The best option depends on the defect and the patient's goals.
Results and follow-up
A successful graft restores coverage and support, with appearance continuing to improve as color and contour settle over months. Some grafts remain slightly different in color or texture from surrounding skin.
Follow-up monitors healing, addresses any wound concerns, and allows for minor revision or scar treatment later if needed.
Medical review
This page is a patient-education resource reviewed by the responsible Norelle Health clinician before publication. It does not replace an in-person evaluation. If symptoms are severe or rapidly worsening, seek immediate medical care.
Specialists who perform free grafts
Dr. Rakhna Araslanova
MD, FRCSC, FACS
Fellowship-Trained Facial Plastic & Reconstructive Surgeon — Facial Paralysis and Reanimation
Dr. Rakhna Araslanova is a fellowship-trained facial plastic and reconstructive surgeon who leads facial paralysis and reanimation at Norelle Health, with additional expertise in craniofacial reconstruction and aesthetic facial plastic surgery.
- Facial paralysis rehabilitation and surgical reanimation
- Craniofacial reconstruction
- Aesthetic facial plastic surgery
- Rhinoplasty
Also caring for this area
Not sure who to see? Our patient coordination team can help match you with the right specialist.
(212) 444-8006Frequently Asked Questions
It is tissue—skin, cartilage, or a combination—that is fully removed from a donor site and placed into a facial defect, where it heals in by developing a new blood supply from the surrounding tissue.
A graft is detached from its original blood supply and depends on the wound bed to survive, while a flap keeps its own blood supply as it is moved into place. Flaps are often used for larger or deeper defects.
Skin is commonly taken from areas with a good color match, such as in front of or behind the ear, the neck, or the upper eyelid; cartilage is often taken from the ear or nasal septum.
Grafts are chosen to match as closely as possible, but some difference in color or texture can remain. This often softens over time, and sun protection helps reduce long-term color changes.
Yes. Partial or complete graft loss can occur, particularly with infection, smoking, or poor circulation. If a graft does not take, additional treatment or a different reconstructive method may be needed.
The graft usually takes within the first one to two weeks, while final color and contour continue to settle over several weeks to months. Your care team provides specific wound care instructions.
Discomfort is generally manageable with prescribed or over-the-counter medication. The donor and graft sites can feel tight or sore in the early days of healing.
Related Conditions
Related Procedures
Request a consultation about free grafts
Schedule a consultation with our team to discuss whether this procedure is the right option for you.