Numbness and Scarring After Mohs Surgery

I am a 48 yr old woman who had Mohs Sx 2 weeks ago. The incision begins at the top of the nose beside the left eye and goes down the left side of the nose and across the tip of the nose. A large portion of my nose is numb and the scarring is not pretty. Am I jumping the gun, or will my results get better? I am not ready to wear this nose even at my age. Thank you

Doctor Answers (11)

Mohs

+2

I would give it at least 6months.  There are many easy things which can improve this type of scar.  As for sensation, it may take many weeks for it to return and you may have some long standing sensation loss.

 

Dr. Malouf


Dallas Dermatologist
5.0 out of 5 stars 74 reviews

Numbness and scarring after Moh's Surgery?

+1
Hello! Thank you for your question! Numbness after any surgical procedure is expected for several weeks to months following. As the nerves to the area are traumatized and will then experience a temporary neuropraxia, a transient loss of nerve conduction. This usually resolves over the next 6-12 weeks, but depending on the procedure performed, sometimes much longer. Typically this should resolve by 1 year. As it goes past this date, the likelihood of the sensation returning is small. However, it can take up to 2 years. If no return from there, it is unlikely to return. It should be discussed that persistent sensory changes may develop following any surgical procedure.  It will take up to a year for scars to fully mature.  Be patient with the results - continue with scar treatment/scar massage as directed by your surgeon, as well as avoidance of UV light by wearing sunscreen or hat.  If after this time the scar is still not to your satisfaction, consideration for scar revision and/or laser, dermabrasion, etc. may be considered. 

The usual signs of the nerves regenerating and neuropraxia resolving is itching, followed by a burning sensation and then occasional sharp, shock-like pains. These will be normal to experience, and actually a promising sign. Usually, normal sensation returns, but is is also possible to have decreased sensation or even increased sensation to the areas affected. Re-educating nerves postoperatively is often helpful and will allow proper instruction for the affected sensory nerves - methods include using different textures to the affected areas when showering, bathing, applying lotion, etc. If bothersome, there are some medications that may be helpful, including Neurontin for pain for hypersensitivity. You can try various textures such as washcloths, loofahs, cotton sheets, etc. Massaging the areas is also beneficial for the incision to make the finest scar possible. The last place to regain the sensation will be directly adjacent to the incision/scar as the nerves will make its way from the periphery to this location. If continual pain arises, evaluation is warranted. After ruling out other causes, one rare explanation may be that a neuroma has developed and may require surgical excision. This is very unlikely unless a large sensory nerve has been transected inadvertently during the procedure. Hope that this helps! Best wishes!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 12 reviews

Healing after Mohs surgery

+1

You are certainly reasonable to have concerns given the location but like others who have answered the question I will emphasize that 2 weeks after surgery is far too soon to judge the final results.  Several aspects about scars improve over the first few weeks to months and often up to a year after surgery.  These include: redness, bumpiness, numbness, visibility. 

Occasionally your surgeon may feel there is some benefit to "touch-up" procedures after the surgery such as dermabrasion (often done 6-8 weeks after surgery) to blend the lines better or laser to hasten the resolution of redness.

The good news is most scars such as yours improve dramatically with time.  In the short run, camouflage makeups specially designed to hide scars may be helpful to you.  Many brands exist e.g. dermablend, coverfx.  Make sure you visit a sales rep or esthetician who can teach you how to apply...

Daniel Berg, MD
Seattle Dermatologic Surgeon

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Duration of Numbness and Wound Healing after Surgery

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It takes 6-12 months to get the final result after any surgery so you may be a little early to be concerned. Numbness is also common and disappears in about 90% of patients. If your cancer was particularly large or deep or involved larger branches of sensory nerves, the likelihood of complete recovery will be less. You might talk to your doctor about treatment options to improve the final cosmetic result. This might include silicone gel products or dermabrasion 2-3 months after surgery.

Andrew Kaufman, MD
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Your body needs time to heal

+1

With time, your scar will improve and most likely your sensation will also return.

Healing can take up to two years... but hopefully you will feel more confident after 2-3 months.

Jeffrey Ellis, MD
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Scars take time to improve after Mohs reconstruction

+1

You have a healthy anxiety about the appearance of your nose but surgery wounds and scars take more than a year to improve.  Numbness quite commonly improves over time with the onset of tingling or "crawling" sensations that develop over many months.  The dorsal nasal advancement rotation flap you seem to have undergone is a very commonly performed reconstruction for nasal tip defects to minimize the distortion of the tip.  There is a displacement of skin from the neighboring nasal dorsum and lateral nose that is being used to distribute the tension and minimize deformity.  In this way, you will obtain maximal textural and coloration match compared with having had a skin graft (usually taken and completely removed from the skin in front or behind the ear and then sewn into the defect as a patch) which often develops a shinier and whiter skin color with loss of pores.  Your flap may benefit eventually with secondary procedures which can help the appearance look better but it is prudent not to rush in and treat early scars.  Sometimes, laser resurfacing, massage, special dressings, corticosteroid injections are used to make the flap look better.  Follow-up with your surgeon and see what they propose.

Ronald Shelton, MD
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Lack of sensation after Mohs surgery

+1

It is very common to cut superficial sensory nerves after Mohs surgery. In most cases, they do come back, but may take time, even as long as 6 to 8 months. With respect to the scar, be patient, It has only been two weeks. It Will get better. I would wait 6 to 8 months before doing anything with the scar. Dr. Behnam.

Ben Behnam, MD
Santa Monica Dermatologic Surgeon
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Numbness and scarring after Mohs micrographic surgery

+1

It is not uncommon to have localized numbness after Mohs micrographic surgery. The good news is that  numbness typically resolves after 3-6 months as there are redundancy in sensory nerve endings. It helps to minimize numbness and scarring with steady circular massage in affected area 4 weeks after surgery, 10 times every 6-8 hours.

William Ting, MD
Bay Area Dermatologic Surgeon
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Scarring and numbness after Mohs surgery

+1

The final appearance of the repair occurs between 6-12 months following the procedure.  The tendency is for gradual improvement over that time-frame.  As one of the responders mentioned, if after 6 months to 1 year you are unhappy with the final appearance, consider consulting with your facial plastic surgeon for treatment options including kenalog (cortisone) injections, dermabrasion, surgical scar revision.

Bryan K. Chen, MD
San Diego Dermatologist
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Scarring after Mohs surgery

+1

It usually takes 6 months for a scar to reach it's least noticable stage. So 2 weeks is too early. Numbness is common but typically resolves as well. Not a bad idea to discuss with plastic surgeon though.

Steven Hacker, MD
West Palm Beach Dermatologic Surgeon
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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.