My Moh's Surgeon has had very limited experience with revisions which is good for how great his results are and perhaps not so good for me if I need a revision. The end of my nose and my upper lip were pulled to the right in order to close the hole. A V-Y flap (Island Pedicle) was used. We communicate amazingly well. I am having a difficult time learning about successful revisions in the area between the nose and upper lip. Where do I turn if needed? My doctor will be my advocate.
Revision After Moh's Surgery
Doctor Answers (7)
Revision following Mohs surgery
Your first and your last sentence would suggest that the doctor whom performed the surgery will not be doing the revision if necessary. Cosmetic and functional result is dependent upon multiple factors including lenght of post op period, type of repair performed, complications afterwards, surgeon's experience in performing the repair, etc. I would recommend that you see a fellow of the American College of Mohs Surgery or the American Society of Plastic Surgery. Check to make sure that the doctor you choose has a lot of experience in lip reconstruction and potentially scar revision and look at some of there before and after pictures if possible (although remember before and after pictures are no guarantee that your result will be similar). I would also respectfully disagree that one person should necessarily do the removal of the skin cancer and another the repair. Mohs surgery traces out the roots of the skin cancer so the surgeon doing the excision is not guessing what the surgical margins or repair should be. As a general rule, the fellowship-trained Mohs surgeon does not determine what repair he or she will perform until after the surgical margins are clear.
Revision issues following Mohs surgery
The best course of action would be to discuss your revision with your surgeon. He or she can explain to you why they chose to approach your reconstruction in the manner that they did.
Pulling of nose and lip after reconstruction after Mohs surgery
You would need to see a physician for a consultation. Your description unfortunately is lacking many details and there is not a photograph attached. If your surgery was just done in the last couple of weeks, you can still expect significant shifting of tissues from the extra skin that grows in reaction to the constant tension. Massaging can help but this can't be done until the wound is strong and that can be six weeks after surgery. When flaps are designed the free margin of surounding cells is take into account so that excessive pulling won't distort permanently.
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Revision after Mohs
Mohs surgeons are guided by the microscopic identification of cancer in a pathology specimen rather than a need to create a smaller defect for simpler reconstruction. Such microscopic mapping takes the guess work out of surgical cancer treatment inherent in simple excisions performed by non-Mohs surgeons. A fellowship-trained Mohs surgeon has significant experience with reconstruction of various areas of face, head/neck, and etc as well as revision of post-Mohs surgery defects by the very virtue of his/her training. Having said that, an honest discussion with your surgeon about their experience in reconstruction of the lip is a must. If after such discussion you feel that you would be comfortable with another surgeon performing the repair, then consulting a board certified Plastic Surgeon with experience in facial reconstruction is a good idea. You can find a fellowship trained Mohs surgeon by contacting American College of Mohs Surgery at 1-800-500-7224 or online at mohs.net
Need Mohs reconstruction revision? Consult an experienced Facial Plastic Surgeon or Plastic Surgeon
Need Mohs reconstruction revision? Consult an experienced Facial Plastic Surgeon or Plastic Surgeon. It's impossible to suggest exactly what will be required to improve your result as no pictures were provided. Typically, scar revision, local tissue rearrangement or debulking excess soft tissue are adequate to optimize Mohs reconstruction results. You should be well cared for by any plastic surgeon with facial Mohs reconstruction experience. It sounds like you've received great care from your Mohs surgeon and that's very encouraging.
Stephen Weber MD, FACS
Reconstruction VS. Revision After Moh's Surgery
It became axiomatic that for best results in eradicating a skin cancer and then reconstructing the defect it would be best if the patient had 2 surgeons; One to remove the cancer and one to reconstruct the resulting defect. The reason is very natural ; if the surgeon removing the cancer knows that he/she also has to reconstruct the defect, they may naturally lean towards removing less, to make the reconstruction easier, and thereby potentially leave skin cancer behind.
While EXPERIENCED Mohs surgeons can close simple defects, they are not all the same when it comes to all reconstructive surgery and especially the reconstruction of more complex defect. In my opinion, it is unfortunate that they even try to be rather than working closely with one or more trusted Plastic surgeons.
Reconstruction of the upper lip and the philtrum can be done in many ways, most of the hardly noticeable. Without a photograph it is impossible to advise you. But - your nose should not be pulled - that implies the surgeon closed the defect under tension. To correct it would require a surgical revision. I would suggest you consult a good Plastic surgeon. Start by looking at wwwPlasticSurgeryorg.
Dr. Peter A Aldea
Revision after mohs
A picture here would have been helpful to see what kind of revision could be performed. Scar revision is a broad term that could entail a z-plasty to redirect the scar to lessen pull/tension and break up an incision line, to dermabrasion to blend in an incision line. With the guidance of your Mohs surgeon you can locate either, another Mohs surgeon from the Mohs college website or a plastic surgeon that would be able to look at you, see the function of the upper lip and determine the type of revision if needed.
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.