Alternatives to Rhinoplasty for Nose Bulge from Mohs

Question

A doctor said there are 3 options to repair the slight bump as a result of Mohs scar tissue. 1. filler in the bridge of the nose to even it out. 2. take a muscle from the scalp and put in the bridge of the nose to even it out. 3. rhinoplasty, his preferred option. shaving the bone down as he put it. Another doctor only recommended rhinoplasty to shave the bone down for the scar tissue bump to fit into and be less pronounced. Rhino seems the way to go, yet a bit drastic just to hide this scar bump. Wondering if there are any less drastic options out there that have not been recommended at this point?

William Portuese, MD · Answer

The external surgery on the nose from Mohs micrographic surgery will definitely leave a scar, that will be permanent. Building up the bridge of the nose can be performed during the rhinoplasty procedure with cartilage taken from the internal portion of the nose. In addition, rasping of the hump should also be performed to give a better aesthetic profile. The only way this would be done is through a rhinoplasty procedure.

Eric M. Joseph, MD · Answer

I read your concern and reviewed your photos. If the bump on your nose is comprised of mostly scar tissue, consider asking your dermatologist if you might benefit from a dilute triamcinolone (Kenalog) injection. A steroid injection may soften the scar tissue and improve the appearance of your nasal profile.

	I hope this is helpful for you.

Kevin Brenner, MD, FACS · Answer

Many defects that result following facial skin cancer removal using Moh's technique require local flap reconstruction. Although many of these flaps can be one stage procedures, it is extremely common for some to require some type of secondary revisional procedure. Small areas of excess tissue, as you are experiencing, are common following local rotation flaps. Many of these will smooth out over time, however a significant number will require a small revision procedure to help refine the contour.

Theda C. Kontis, MD · Answer

Mohs surgery is  procedure named for Dr. Frederick Mohs, who developed this skin cancer removal technique while he was a medical student. Mohs surgery involves removal of a skin cancer by checking microscopic margins to assure complete removal of the tumor while limiting the amount of normal tissue removed. It is commonly used for skin cancers of the nose, eyelid, lip, ear......places where you want to remove the smallest amount of tissue possible and still remove the whole tumor. Once Mohs surgery is performed, the resultant defect (hole) is repaired, usually with a skin graft, skin flap, or sometimes it heals the best without any repair at all.

	Your photos show that the surgeon used a skin flap to repair the defect left in your nose after the skin cancer removal. This flap has caused elevation of the tissue in one area causing a bump, and a depression above the bump where there is scar.

	It doesn't make any sense to me for you to have a rhinoplasty, since there has been no nasal bone or cartilaginous change to your nose, you just have a soft tissue problem. It also seems overly aggressive to have a "muscle from your scalp" placed. With the large defect you have, I think it would not be advisable to use filler as a first option.

	Although it is hard to tell for sure without examining you, my inclination would be to work on the soft tissue scar, since you were happy with your nose before the Mohs surgery. The flap could be thinned surgically under local anesthesia, possibly steroid injected, and if there was still a deformity superiorly, maybe a little filler could even things out. I agree with your feelings that something "less drastic" should be done.

Carlos L. Wolf, MD · Answer

With out the benefit of touching your nose I will make either one of two assumptions. If the bump is hard and you had it before your surgery you would need a rhinoplasty to remove it. If the bump is made up of soft tissue and you did not have it before the surgery a simple injection of steroid  to diminish the scar and swelling would probably work very well.

	Good luck.

Alternatives to Rhinoplasty for Nose Bulge from Mohs

Answers (17)

Answer: Treatment for nose bulge from Mohs

Answer: Treatment for nose bulge from Mohs

Answer: The scar tissue that's causing the bump on your nose may improve with a dilute triamcinolone injection.

Answer: The scar tissue that's causing the bump on your nose may improve with a dilute triamcinolone injection.

Answer: Nasal defect after Moh's closure is likely from the flap reconstruction performed

Answer: Nasal defect after Moh's closure is likely from the flap reconstruction performed

Recommended reading

Everything you need to know about Rhinoplasty

Answer: No rhinoplasty after nasal Mohs surgery

Answer: No rhinoplasty after nasal Mohs surgery

Answer: Noses bump after Mohs surgery

Answer: Noses bump after Mohs surgery

Our mission is to create a world where every investment in modern beauty is Worth It.

Alternatives to Rhinoplasty for Nose Bulge from Mohs

Answers (17)

Answer: Treatment for nose bulge from Mohs

Answer: Treatment for nose bulge from Mohs

Answer: The scar tissue that's causing the bump on your nose may improve with a dilute triamcinolone injection.

Answer: The scar tissue that's causing the bump on your nose may improve with a dilute triamcinolone injection.

Answer: Nasal defect after Moh's closure is likely from the flap reconstruction performed

Answer: Nasal defect after Moh's closure is likely from the flap reconstruction performed

Recommended reading

Everything you need to know about Rhinoplasty

Answer: No rhinoplasty after nasal Mohs surgery

Answer: No rhinoplasty after nasal Mohs surgery

Answer: Noses bump after Mohs surgery

Answer: Noses bump after Mohs surgery

Browse related questions

Our mission is to create a world where every investment in modern beauty is Worth It.