What can I expect after Moh's surgery if I let the scar heal on its own? I was told by a plastic surgeon that I could let it heal on its own, do a skin graft or nasal flap. I am curious as to how the body would heal on its own and what would the results look like? Because of large pores on my nose, I am afraid a skin graft would be very obvious. If it healed on its own, would it be more likely to match the adjacent skin? I am 84 years old and feel a nasal flap is too much surgery.
What Happens to Mohs Surgery Scar when Healed by Itself?
Doctor Answers (12)
Mohs surgery wound allowed to heal by itself
It's amazing how well the skin can heal on its own (called healing by secondary intent). It may possibly be depressed after healing or heal over too much (become a raised bump). If it heals too much, that can easily be repaired. A depression is more difficult to repair but can be done possibly be dermal implant or filler. If you're not happy with how it looks you can always opt to have more surgery later.
Secondary intention healing after Mohs Surgery
Secondary intention healing is an excellent choice for certain defects that result after a Mohs surgery. Generally speaking concave areas of the face, ideally, perialar areas (around the nostrils) that are concave, heal excellent by secondary intention.
Usually not the best choice: Nasal skin is thicker
Although I agree with other posts which state that healing by secondary intention of a Moh's defect is sometimes appropriate, it is generally in the minority of situations. The reason for this is that nasal skin is thicker and more sebaceous than other area of the face. In addition, it is supported by relatively flexible underlying cartilaginous structures.
Healing via secondary intention on the nose relies on wound contraction which can lead to distortion of varies nasal subunits, and a mismatch in nasal topography. The other factor is the time involved; this form of healing can take months.
I almost always use some form of skin flap (usually a bilobe flap) which replaces both the skin and underlying muscle of the nasal defect. This allows for a texture and thickness match not allowed for by skin grafts and healing via secondary intention. For larger nasal defects, a more advanced flap (paramedian forehead flap) is sometimes employed. Due to the downtime associated with this flap, some patient elect to have simpler reconstructive options. However, the aesthetic results from this flap are typically excellent.
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Mohs on the Nose
Depending on the size and location of the surgical defect, second intention healing can give a better cosmetic result than having reconstructive surgery. However, it is not appropriate in all cases.
If matching the adjacent skin is a concern, a flap or complex closure depending on the size and location of the nasal defect will give a better match to the adjacent nasal skin. The level of care required will be greater with the flap, but the aesthetic results after it has completely healed will be worth it.
If you decide to let the wound heal on it's own and you are not satisfied with the final outcome, a revision procedure can be planned with your reconstructive surgeon.
Wound Healing after Mohs surgery
Letting the wound heal by itself or "secondary intention healing" is frequently the best option for some surgical wounds. Surgical wounds on concave (slightly depressed inward) areas tend to heal best, such as the bowl-shaped area near the ear canal, the area between the nose and eyelid, and the temple. The Mohs surgeon is probably in the best position to determine what needs repair and what can heal on its own.
Healing without reconstruction (second intention healing) may be a good choice after Mohs surgery
The wound (defect) created after Mohs surgery will need some sort of approach to yield the best result. This can involve primary stitching or more involved movement of neighboring skin (flap) or skin from another site (graft). In some cases the final result from allowing a wound to heal on its own is comparable (or even better) than a surgical reconstruction. This is primarily dependent on the size of the wound and the location on the face. An experienced Mohs surgeon or plastic surgeon can give you the best advice on the likely and possible outcomes if you were allow the wound to simply heal on its own. In my practice, second intention healing is a perfectly good choice in some patients. In many cases, as well, the wound will shrink as it heals yielding a smaller scar. If the final scar is bothersome, in many cases, it can be revised in a subsequent procedure (laser, surgical or other). I find showing pictures of similar wounds and how they did to be quite helpful in allowing patients to understand what to expect
Mohs surgery wounds can sometimes heal well on their own.
If the Mohs surgery location on your nose is in the concave part on the side just above your nostril, this is an excellent location for healing by itself (also known as healing by secondary intention, or granulation). Your Mohs surgeon or plastic surgeon should evaluate whether letting the wound heal this way might cause collapse of the nostril when you try to breathe in through your nose. If there is no risk of collapse, and you don't feel like more surgery, I think allowing it to heal is a fine option, as long as you understand it can take longer and still requires wound care until healed.
Mohs surgery scar healed by itself
You seemed to have answered your own question. If you feel you are too old for a nasal flap or worried about the skin grafts appearance, than by all means allow the wound to heal by secondary intention. Than you can decide if the appearance of the scar is acceptable to you. If you are not happy you can always have surgery.
Regards from Miami
Moh's healing by secondary intention
Moh's excisions were originally intended to heal by the wound shrinking and scarring over (secondary intention). Sometimes this works well and in some areas it draws the tissues together into a distortion of the facial features.
Wound healing and reconstructive surgery after Mohs Micrographic surgery
Healing by secondary intention may be appropriate for concave areas such as the temple, or the inside aspect of a ear (such as the scaphoid area of the ear). However, unless the defect is quite small, it may not offer the best cosmetic outcome on the nose as there will be some contraction leading to a likely depressed scar and some subtle or not so subtle distortion of the nasal contour, e.g. asymmetric flare of nostrils. Flap repair such as bilobed or rotational flap repair may be more preferable to skin graft placement as there may be a semi-permanent 'bubble gum patch' appearance on the nose associated with a skin graft repair.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.