Daniel Berg, MD

Grafts (and all surgical wounds) tend to improve with time, particularly redness.  This may be true up to a year after surgery.  Persistent redness that does not go away can be treated with laser in many cases (e.g. pulsed dye laser).  Persistent texture irregularity can also be treated with laser or dermabrasion.

The majority of Mohs surgeons are dermatologists who have received training during residency in surgery of the skin including reconstruction.  Members of the American College of Mohs Surgery in addition have at least one year of fellowship during which time they focus intensely on Mohs surgery and reconstruction. 

Most Mohs surgeons perform most of their own reconstructions - and the vast majority of patients are satisfied with the results of both the Mohs surgery and reconstruction. Mohs surgeons may often have more experience in reconstructing Mohs surgery defects than some plastic surgeons who may spend much of their time doing other procedures.

Having said that, of course many Plastic surgeons also  are experienced in reconstruction of facial defects as well.  In some cases they may bring some additional expertise or experience to bear that makes it an advantage to have them do the reconstruction.  Most plastic surgeons have access to intravenous sedation or general anesthetic which may be necessary or preferred (especially in larger cases) although local anesthesia has many advantages as well.

It is wise to consult with your Mohs surgeon before the surgery to discuss how they would reconstruct the likely defect after Mohs and if they are comfortable and experienced with cases like yours.  Some patients like photos or diagrams (some do not!). There are no guarantees as to outcome regardless of who does the surgery, and most surgical wounds take weeks to months to fully mature/heal regardless of who does it.  Asking these questions up front will help you feel comfortable with your decision.

It is important to rule out a skin cancer in any case where there is a non-healing sore.  Both basal cell and squamous cell carcinomas can present at the entrance of the nostril and squamous cell carcinoma can arise deeper into the nose.

The best way to investigate this would be to get an asssessment by an experienced dermatologist or head and neck surgeon (Ear, Nose and Throat Surgeon).  They can examine you, look at the spot and perform a biopsy if needed.

It is common for hairs to shed after a transplant and they may come out with some of the crusting.  Fortunately, At two weeks post surgery, it would be unusual to have the actual hair root (graft) come out with the crust - the hairs should be well engrafted by then, 

For general information, a skin graft often goes through a "healing phase" in the first couple of weeks where it can appear discolored in part or even in whole.  Parts of the surface may also have some changes.  In many cases this is within the normal range and does not predict a poor outcome.  Like all facial surgeries, scars tend to improve significantly with time...





The only way to judge if your healing is normal is to have the surgeon take a look and if you are still concerned that is recommended.