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Can Scar Be Fixed After Mohs?

Can it be fixed? Should it be fixed? The photo shows my left eye 10+ weeks after a skin graft following Mohs surgery to remove a basal cell lesion. Even with daily massage, the scar remains very hard and lumpy. The graft pulls down my inner eyelid to the point that I have to reach in with a q-tip just to clean my eye. In the photos, my nose appears crooked but it is not (or wasn't). The graft had all bunched up right after the exterior stitches were removed and I think that's why it's so lumpy.

Doctor Answers (11)

Skin grafts change appearance over 18 months

+2

There is a long maturation for skin grafts. Many that get lumpy initially flatten over time and others that are flat can raise up. The surgeon can show you how to massage the area and sometimes, if it doesn't flatten, corticosteroids can be injected to make it flatter faster but there are risks that the surgeon can discuss with you.

Manhattan Dermatologist
5.0 out of 5 stars 31 reviews

Medial Canthal Area Scar Can be Fixed

+2

Full thickness skin grafts in the medial canthal area can heal up beautifully but can also get the fibrotic reaction that occurred to you.  When this happens, it is usually best to remove the entire graft and use a local flap instead.  The size of the defect is small enough that it likely could be done in the clinic under local anesthesia.

Minneapolis Facial Plastic Surgeon
5.0 out of 5 stars 3 reviews

Scar revision

+2

Yes, the area (scar) can be revised but you should wait about 3 months after surgery before you do anything else.  I recommend consultation with an oculoplastic surgeon familiar with eyelid/canthus anatomy for reconstruction.

Dr Taban

Beverly Hills Oculoplastic Surgeon
5.0 out of 5 stars 4 reviews

Can the graft be fixed

+2

You are still early after the graft placement, but yes the area can be addressed and revised so that scar contraction does not pull on your medial canthus.

Germantown Dermatologist
5.0 out of 5 stars 3 reviews

Scars after Mohs Surgery can be improved / fixed

+1

Yes, in most situations, scars after Mohs surgery can be improved ("fixed").  See your dermatologic surgeon and tell him or her your concerns;  so that he or she may properly evaluate the scar, discuss with you the various treatment options and formulate a plan for improving your post-Mohs Surgery scar.

Las Vegas Dermatologist
4.5 out of 5 stars 6 reviews

Scar Improvement After Mohs Surgery

+1

Ten weeks is a relatively short period following reconstruction. As a general rule, it takes about 6-12 months to reach the final "result" after any type of surgery. However, there are some things that can be done at 10-12 weeks to "fine tune" your result, including injections of steroids to soften the scar and dermabrasion (a.k.a scarabrasion) to help blend in the scar with the surrounding skin. Talk to the doctor who performed the surgery about what your options are to improve the final cosmetic appearance.

Web reference: http://www.emohs.com

Los Angeles Dermatologic Surgeon
4.0 out of 5 stars 4 reviews

Options for scar revision after Mohs surgery

+1

You might benefit from a steroid injection to soften or loosen up the hypertrophic scar.  Time will also help the scar improve.  CO2 laser resurfacing would help smooth out the bumpiness and irregularity of the scar--this is usually performed about 6 months after the initial surgery.

Web reference: http://www.eastbaylaser.com/EastBayLaser/Welcome.html

Walnut Creek Dermatologic Surgeon
4.5 out of 5 stars 11 reviews

Skin graft

+1

~ 10 weeks out is still relatively early in the postop period for skin grafts.  It will improve over the next several weeks and months.  Revision is possible to help improve the appearance however.  If you are developing a medial ectropion then you may want to seek consultation with an oculoplastics surgeon. 

Orlando Oculoplastic Surgeon
4.5 out of 5 stars 2 reviews

Patience may be the best bet to allow scars to improve after Mohs surgery

+1

Facial surgical scars often look worse in the first few weeks (or months) and improve often dramatically with time.  This may account for the popularity of scar creams (patients tend to use them while the scars are spontaneously improving over time and then give credit to the cream!).  The trick is time.  I don't think you can judge the final outcome of the scar until about a year after surgery (some feel even longer).

 

There is a good chance that the redness, lumpiness and pulling all will improve over the next 9-10 months with no intervention.

If you want to intervene earlier, simple options include dermabrasion (with laser or by hand).  More complicated options (that restart the wound healing "clock") include removal of the graft and replacement with a flap - suggested by a colleague on this website.

This is a good case for a discussion with your doctor.  As you can see from the answers posted, there are a variety of approaches that the doctors on this site are recommending.  Don't forget the option of time though!

Seattle Dermatologic Surgeon

Repair of graft after Mohs

+1

Based on your photos, I believe this can be drastically improved with a simple 5 minute procedure with superficial planing and manual dermabrasion.

Dr. Malouf

Dallas Dermatologist
4.5 out of 5 stars 61 reviews

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.