Eight weeks ago I had Moh's and reconstructive surgery between the upper lip and right nostril. I have railroad tracks and a "puffy pillow" at the bottom point of the Island Pinacle that have been present since the stitches were removed. Perhaps a combination of too tight and in too long on the stitches. They were taken out 6 days after surgery and that is probably appropriate for an area of tension as the mouth is. I understand that I should wait a year for revision. What can I do now?
Successful Revisions Done on Mohs Reconstruction Lip Area Following Mohs?
Doctor Answers (5)
Be patient with Mohs healing
It is far too soon to be concerned with the appearance of you Mohs repair at 8 weeks. In my office I recommend gentle massaging and use of a bioCorneum scar gel- which also has an SPF 30. If you still have concerns in 6 months, you may choose to undergo a series of skin resurfacing procedures with a laser- such as the Artisan -which has proven results for minimizing the appearance of scars. As always, it is best to share your concerns with your surgeon. Best of luck, Dr. Clevens
Revision of scar after lip reconstruction after Mohs surgery
I think your surgeon did a very good job reconstructing a difficult area and you will continue to get improved results over the next several months. You had an island pedical flap and there is a normal inversion of the incision lines because of the pulling of the surrounding tissue. Surgical revision if necessary can be done six months to a year after, but Fraxel Resurfacing or other modalities such as dermabrasion, can be done as early as six months to two months after surgery to revise the texutre the skin incision crease. As this crease catches shadows and makes he incision more noticable, it might be prudent to evaluate this option.
Pedicle flap on the lip
Tincture of time will be the best way of handling it at this time! Lips notoriously hold on to swelling and may take a little while for it to resolve. How much time? It is difficult to say at this time. However, you can place a finger inside the mouth and another on top of the scar and swelling and gently massage the area for about 30 seconds several times a day. You will know more about the final appearance of the flap by 3 months after surgery, but improvements will continue to occur for a full year. If you are still unhappy with the result at that time, make sure to discuss it with your doctor.
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At eight weeks, it is still very early to pass judgement on this repair. That area of the upper lip is very challenging to reconstruct and V-Y Advancement Flap (previously referred to as the island pedicle flap) is a very good choice at this location. Massaging the area should help. I would also bring your concerns up to your surgeon. Sometimes, intralesional kenalog will help with pincushioning.
Swelling is normal following Mohs reconstruction - will improve with time and gentle massage.
Swelling is normal following Mohs reconstruction - will improve with time and gentle massage. My first recommendation would be to followup with your reconstructive surgeon and ask the same question. You've provided very nice photos and it appears that you've probably undergone V-Y advancement repair which is a very nice technique for repair of Mohs defects of the lateral upper lip. Time will improve the swelling as well as gentle massage. At 8 weeks there is no risk of opening the wound or widening the scar and massage can speed the resolution of edema (swelling) as well as soften the tissue. Lastly, I will add that you appear to have a very nice result at this point and your surgeon has done a great job.
Stephen Weber MD, FACS