Background Non-melanoma skin cancers (NMSCs) are the most common cancers treated in Australia, and Australia has the highest incidence of NMSCs in the world. Most small or simple BCCs are treated by general practitioners (GPs) in their clinic, whilst larger or more complex lesions are usually referred on to plastic and reconstructive surgeons. Case A 67 year old male was referred for management of profound cutaneous telangiectasia, sensory loss, and hyperhidrosis affecting his central forehead 18 months post excision of a nasal basal cell carcinoma (BCC). After excision, the defect was unable to be closed primarily, and it was reconstructed with a Rintala flap. Following the procedure, an area of absent sensation, profound and obvious telangiectasia and hyperhidrosis developed in his central forehead. Treatment with vascular laser resulted in minimal improvement. Ultrasound of the scars showed a tortuous right supratrochlear vessel that was significantly dilated compared to the contralateral vessel (2mm vs 1mm). This vessel was explored and ligated surgically, with subsequent complete resolution of the telangiectasia. Discussion We suspect the patients post operative symptoms resulted from damage to the tunica adventitia and associated sympathetic innervation of the affected supratrochlear vessel, without intimal disruption, leading to loss of sympathetic tone and subsequent downstream vasodilation. Ligation of the vessel resulted in local reduction in flow and resolution of the telangiectasia. This case illustrates a rare complication, but highlights the importance of careful design and execution of local flaps, particularly the handling of vessels.