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.
Can Scar Be Fixed After Mohs?
Doctor Answers (11)
Skin grafts change appearance over 18 months
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.
Medial Canthal Area Scar Can be Fixed
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.
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.
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Can the graft be fixed
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.
Scars after Mohs Surgery can be improved / fixed
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.
Scar Improvement After Mohs Surgery
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.
Options for scar revision after Mohs surgery
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.
~ 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.
Patience may be the best bet to allow scars to improve after Mohs surgery
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!