One of the most important but commonly neglected functions of the face is social communication (Jack, 2015). Facial deformities, both congenital and acquired, adversely affect social functionality regardless of age, gender, and educational level (Rankin, 2003). Studies have revealed that facial disfigurement causes depression, anxiety, low self-esteem, interpersonal tension, and social avoidance (Partridge, 1993; Ye, 1998; Butler, 2000). The nose, being in the center of the face, plays a vital role in body image and has psychological importance (Goin, 1991; Amodeo, 2007). According to the literature, appearance-related social dysfunction has roots in anxiety and depression, and may lead to social avoidance (Partridge, 1993; Ye, 1998; Tebble et al., 2006). To more comprehensively understand the psychological adjustment of patients with nasal defects, patient-report questionnaires have been used to study appearance satisfaction, anxiety, depression, and social avoidance.

To achieve ideal nasal reconstruction outcomes in patients with nasal defects, the forehead flap is the preferred method because the pedicle is reliable, the soft tissue is ample, and the skin texture match is excellent (Brodland, 2005; Menick, 2009; Correa et al., 2013; Shokri et al., 2019). However, it is a staged procedure, and patients endure the inconvenience of facial deformities and healing for 2–4 weeks before flap division. This lengthy process may increase patients' psychological distress, but this aspect of reconstruction has not been thoroughly studied. Previous studies have been largely retrospective and focused on psychological effects after rhinoplasty, whereas nasal reconstruction with a forehead flap has been barely studied. Therefore, our purpose was to prospectively investigate patients’ psychological adjustment and the effect of nasal reconstruction with a forehead flap on social functioning.