What Happens to Mohs Surgery Scar when Healed by Itself?

Although I agree with other posts which state that healing by secondary intention of a Moh's defect is sometimes appropriate, it is generally in the minority of situations. The reason for this is that nasal skin is thicker and more sebaceous than other area of the face. In addition, it is supported by relatively flexible underlying cartilaginous structures.
Healing via secondary intention on the nose relies on wound contraction which can lead to distortion of varies nasal subunits, and a mismatch in nasal topography. The other factor is the time involved; this form of healing can take months.
I almost always use some form of skin flap (usually a bilobe flap) which replaces both the skin and underlying muscle of the nasal defect. This allows for a texture and thickness match not allowed for by skin grafts and healing via secondary intention. For larger nasal defects, a more advanced flap (paramedian forehead flap) is sometimes employed. Due to the downtime associated with this flap, some patient elect to have simpler reconstructive options. However, the aesthetic results from this flap are typically excellent.

Healing by secondary intention may be appropriate for concave areas such as the temple, or the inside aspect of a ear (such as the scaphoid area of the ear). However, unless the defect is quite small, it may not offer the best cosmetic outcome on the nose as there will be some contraction leading to a likely depressed scar and some subtle or not so subtle distortion of the nasal contour, e.g. asymmetric flare of nostrils. Flap repair such as bilobed or rotational flap repair may be more preferable to skin graft placement as there may be a semi-permanent 'bubble gum patch' appearance on the nose associated with a skin graft repair.

Thank you for your
question. Allowing the wound to heal by secondary intention is certainly an
option. The wound may take several weeks to months to completely heal. If you
are not satisfied with the results you can always discuss further reconstructive
options with your plastic surgeon.

Depending on the size and location of the surgical defect, second intention healing can give a better cosmetic result than having reconstructive surgery.  However, it is not appropriate in all cases.  

If matching the adjacent skin is a concern, a flap or complex closure depending on the size and location of the nasal defect will give a better match to the adjacent nasal skin. The level of care required will be greater with the flap, but the aesthetic results after it has completely healed will be worth it.  

If you decide to let the wound heal on it's own and you are not satisfied with the final outcome, a revision procedure can be planned with your reconstructive surgeon.

 

It's amazing how well the skin can heal on its own (called healing by secondary intent).  It may possibly be depressed after healing or heal over too much (become a raised bump).  If it heals too much, that can easily be repaired.  A depression is more difficult to repair but can be done possibly be dermal implant or filler.  If you're not happy with how it looks you can always opt to have more surgery later.