I had Mohs surgery just over two years ago. The scar is wider than desired. It is hypopigmented (which is not so visible on the photos) with suture "railroad track" marks (also white) in the superior portion of the scar. There is also an unresolved dog ear at the bottom. wonder whether this is a decent outcome for a favorable area like the cheek or is it a poor outcome that could benefit from some form of scar revision. If the later, what kind of scar revision modality would you recommend?
I Had Mohs Surgery Just over Two Years Ago. The Scar is Wider Than Desired? (photo)
Doctor Answers (4)
Moh's surgery scar revision - Los Angeles
I treat many scars with scar revision, incuding Mohs surgery scars. You may need a combination of laser, scar resurfacing, and surgery. Raffy Karamanoukian Los Angeles
Mohs surgery and scar
Mohs surgery is the most tissue sparing way to treat a skin cancer and that often translates to having an optimal cosmetic result. There will always be a scar following removal of a cancer and how well the scar heals depends on the skill of the surgeon (Did you see a fellowship trained Mohs surgeon who is a member of the American College of Mohs Surgery?), as well as how well the scar was cared for and the genetics of the patient (some patients heal better or faster than others). If you have issues with the appearance of the scar, there are many many ways to improve the appearance of the scar and they do not need surgery necessarily. Often some dermabrasion or laser resurfacing can easily address the issues you are mentioning and lead to significant improvement in them.
Scar after Mohs
Remember that the purpose of a Mohs procedure is to remove the cancer and to preserve as much tissue as possible in the process. With that being said, there is a possibility to do a scar revision after the fact, after the area is well healed. At two years out, this would be a good time. Consult with a dermatologic surgeon or plastic surgeon about how to perform the best type of revision (or possible laser or resurfacing treatments) to reduce the scar.
"This answer has been solicited without seeing this patient and cannot be held as true medical advice, but only opinion. Seek in-person treatment with a trained medical professional for appropriate care."
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Mohs surgery scar improvement
I think you best option for improvement of this scar would be a fractionated laser treatment such as the Fraxel. It will help blend in the scar color and help hide the track marks you see. You will likely need a few treatments but I have seen the Fraxel laser do an amazing job at camoflauging such scars.
If the redundancy (aka dog ear) is bothersome, that can be surgically removed relatively easily--it will simply require a small procedure to remove the excess tissue and stitches will be in for a week.
Do the revision before the laser if you are going to address both issues so that the laser can hide the new incisional scar as well.