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Alternatives to Rhinoplasty for Nose Bulge from Mohs
asked 1 year ago by anon
Latest answer by William Portuese, MD
Question viewed 1,175 times
Tags: female, alternative, bulging, scar tissue
As you can see the bulge on my nose. I had a fairly straight nose before Mohs, with a slight bump. Scar tissue from Mohs just enhanced it big time.
A doctor said I have 3 options.
1. filler in the bridge of my nose to even it out.
2. take a muscle from my scalp and put in the bridge of my nose to even it out.
3. rhinoplasty, his preferred option. shaving the bone down as he put it. Another doctor only recommended rhinoplasty to shave the bone down for the scar tissue bump to fit into and be less pronounced.
Rhino seems the way to go, yet a bit drastic just to hide this scar bump. Wondering if there are any less drastic options out there that have not been recommended at this point?
17 answers to Alternatives to Rhinoplasty for Nose Bulge from Mohs
+3
Treatment for nose bulge from Mohs
The external surgery on the nose from Mohs micrographic surgery will definitely leave a scar, that will be permanent. Building up the bridge of the nose can be performed during the rhinoplasty procedure with cartilage taken from the internal portion of the nose. In addition, rasping of the hump should also be performed to give a better aesthetic profile. The only way this would be done is through a rhinoplasty procedure.
+3
No rhinoplasty after nasal Mohs surgery
Mohs surgery is procedure named for Dr. Frederick Mohs, who developed this skin cancer removal technique while he was a medical student. Mohs surgery involves removal of a skin cancer by checking microscopic margins to assure complete removal of the tumor while limiting the amount of normal tissue removed. It is commonly used for skin cancers of the nose, eyelid, lip, ear......places where you want to remove the smallest amount of tissue possible and still remove the whole tumor. Once M
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+3
Consider using a Filler
There are several options here for this type of post MOH's nasal deformity which I have seen a lot over the years. The best option is to do a filler above the bulge to give the appearance of a natural dorsum using Restylane which is the best HA filler for the nasal dorsum. It will last almost 2 years and by that time the rest of the MOH's deformity will have settled down in most instances so no further surgery is needed.
+3
Best treatment options for Nasal Bulge following Moh's Surgery
Preceived deformities following early rhinoplasty may get worse as the swelling subsides but some will get better. This is the reason all postop rhinoplasty deformities should be treated conservatively and definitive treatment started only after the cause of the deformity has been determined. The "experts" are at a disadvantage in this case as it is unknown how long ago the operation was performed and are not able to feel the...
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+3
Correcting Nasal Deformities After Mohs Surgery
There are several alternatives to correct contour deformities of the nose that arise after Mohs surgery. These include a formal rhinoplasty to reshape the nose, fillers to fill slight depressions or camoflauge irregularities, local flaps to rearrange the soft tissue (skin) envelope, or soft tissue augmentation (building up) -- a thin layer of scalp tissue, called fascia, is frequently used.
The extent of the deformity will dictate which technique will provide the best result...
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+2
Noses bump after Mohs surgery
With out the benefit of touching your nose I will make either one of two assumptions. If the bump is hard and you had it before your surgery you would need a rhinoplasty to remove it. If the bump is made up of soft tissue and you did not have it before the surgery a simple injection of steroid to diminish the scar and swelling would probably work very well.
Good luck.
Carlos Wolf, MD
Miami Facial Plastic Surgeon
Miami Facial Plastic Surgeon
+2
Nasal Bump After Mohs
The options you have been given are excellent. There are a couple more. I agree with one of the other physicians that I would like to know how long it has been since your excision/repair and I would also like to do exactly what was done. It appears that you had a straight line closure of the wound.
If it has been a relatively short time since the procedure (less than a year) and it still feels firm, I would suggest waiting with/with out steroid injections into the scar tissue. I...
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D.J. Verret, MD
Dallas Facial Plastic Surgeon
Dallas Facial Plastic Surgeon
+2
Alternatives for nasal depression.
If you are happy with rest of the nose I would use a combination of soft tissue over cartilage to fill in the dent. Though fillers can improve this, they would fall short of correction, be expensive and need to be redone every year or two. Make sure you see an experienced rhinoplasty surgeon for this problem for the best result.
+2
Nasal options
It does seem as though the options given to you are very reasonable though another would be to rotate a forehead flap down to get the full thickness of the tissue and eliminate the indent. Basically, you either fill in the dent or plane down the bump. It really depends on examining you and what seems to you like it is going to give you the best overall look. Either approach is reasonable.
+1
The scar tissue that's causing the bump on your nose may improve with a dilute triamcinolone injection.
I read your concern and reviewed your photos. If the bump on your nose is comprised of mostly scar tissue, consider asking your dermatologist if you might benefit from a dilute triamcinolone (Kenalog) injection. A steroid injection may soften the scar tissue and improve the appearance of your nasal profile.
I hope this is helpful for you.
+1
Nasal deformity after Moh's
I would wait for 6 months to see if the scar has flattened. Steroid injection is a good option while waiting. If the soft tissue bump from the Moh's scar is still unacceptable I would try scar revision first followed by laser resurfacing. With your skin type this should be satisfactory if you were happy with the shape of your nose prior to the Moh's. Otherwise a rhinoplasty will be in order. However I will not alter the bone to fix the soft tissue deformity.
Norman Ge, MD
Orange County Facial Plastic Surgeon
Orange County Facial Plastic Surgeon
+1
Nasal defect after Moh's closure is likely from the flap reconstruction performed
Many defects that result following facial skin cancer removal using Moh's technique require local flap reconstruction. Although many of these flaps can be one stage procedures, it is extremely common for some to require some type of secondary revisional procedure. Small areas of excess tissue, as you are experiencing, are common following local rotation flaps. Many of these will smooth out over time, however a significant number will require a small revision procedure to help refine...
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+1
Rhinoplasty
To give you a resonable answer, I would need to know how long ago your cancer surgery was done and what reconstructive technique was used following your Mohs surgery. If this is recent, this may all just be scar tissue that would represent a soft tissue deformity that would not be addressed with a rhinoplasty. A rhinoplasty would affect the underlying bony structure.
You should also consider the possibility of a recurrence of your skin cancer. Make sure you see your...
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Jack Peterson, MD
Topeka Plastic Surgeon
Topeka Plastic Surgeon
+1
Correcting Nasal Deformity
The three options given are all excellent. However, there is another option since you had an acceptable nose before the Moh's surgery. The present defect should be mostly soft tissue, and a local skin excision/remodeling may also work. The Rhinoplasty option is reasonable if the "slight hump" you had before surgery was very bothersome.
Robert T. Buchanan, MD
Highlands Plastic Surgeon
Highlands Plastic Surgeon
+1
Nasal scar deformity from Mohs procedure needs revision
Repair of a defect on your nose after a Mohs excision for skin cancer can leave a dent, lump or other visible deformity. If nothing was 'wrong' with the shape and appearance of your nose before the skin cancer procedure it seems unlikely that rhinoplasty is now the solution. We suggest you see another board certified plastic surgeon, and if the scar is a year or older, revision and correction of the scar is in order. A repair such as this should be covered under your health insurance...
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Peter E. Johnson, MD
Chicago Plastic Surgeon
Chicago Plastic Surgeon
+1
Non Surgical Rhinoplasty
Dear rhinoplasty patient,
I reviewed your post Mohs surgery’s photo. It appears that the scar formation after your Mohs surgery has created the bump on your nose. All options that were given to you by your PS are great alternatives to treat your nose. I would go with a conservative option. First, I would inject the area with small amount of Kenalog, and then in three months, I would inject Radiesse to the bridge of your nose. Good Luck
+1
Alternatives to Rhinoplasty for Nose Bulge from Mohs
What a GREAT question and the photos are the best I have seen posted by a questioner. Your doctor has done a correct informed consent, giving you 3 alternatives treatments. From the posted photos I recommend a modified rhinoplasty to improve the appearance. Do not waste your time and $'s for fillers. Filing can improve but for a aesthetic result on you I would not recommend this. As for a forehead Vto Y flap very bad because of the scars left. Best from MIAMI Dr. Darryl j. Blinski
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