Treatment options for pincushion and bump after MOHS bilobed flap repair? (Photo)

Question

I am about 1-month post-op after I had MOHS surgery to remove BCC on my ala. Afterwards, a plastic surgeon performed a bilobed flap to close the wound. The top portion of the nose seems to be healing well, but I am admittedly upset with the result, as there is a bump above my alar groove, and the lower flap seems to have a considerable amount of pincushioning.

Raffy Karamanoukian, MD, FACS · Answer

Moh’s surgery on the face often requires surgical repair and reconstruction to reapproximate the skin edges. Flaps or direct closure techniques are used. It is important that you optimize scar healing during this phase in order to reduce longterm scars. For red scars, we use Vbeam laser, followed by fractional laser for scar topography and contour. We recommend Plato’s Scar Serum twice daily for the immediate postoperative period. Fractional laser is safe for scar laser therapy. 
There are treatments for swelling and edema of the scars. If there is residual sutures or edema, we advise you to follow a scar treatment protocol that can minimize the time to recovery. Our office specializes in scar revisions for Moh’s surgery. 
Best, 
Dr. Karamanoukian
Realself100 Surgeon

Peter J. Jenkin, MD, FAAD · Answer

I would suggest starting with injections of cortisone into the lumpy part of the scar.  This can be done more than once if necessary.  Any residual unevenness can then be smoothed out with a simple in office dermabrasion.  Good luck.

John Louis Ratz, MD · Answer

Pin cushion defects are not uncommon with the bi-lobed flap, and there are several options for improvement.. One option is to surgically lift the defects and remove the excess underlying tissue. The flap can then be reattached. The other is to have the defects "sculped" with CO2 laser resurfacing. I prefer the laser method by far. However, in either case, the result is only as good as the experience and skill of the person performing the procedure.

Treatment options for pincushion and bump after MOHS bilobed flap repair? (Photo)

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Treatment options for pincushion and bump after MOHS bilobed flap repair? (Photo)

Answers (3)

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Everything you need to know about Mohs Surgery

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