What are realistic post-op care expectations following eyelid surgery for skin cancer & reconstruction?

Question

I need surgery on my lower eyelid to remove skin cancer, which will require possible reconstruction by a plastic surgeon. I am trying to decide where to go for this and who to use, and I'd like to have realistic expectations. Some surgeons would see me after surgery and through healing; others would only see me at 6 or 8 weeks after (with a med asst removing sutures prior to that). What should a realistic expectation be for post op care?

Kenneth D. Steinsapir, MD · Answer

Mohs surgeons are dermatologists how are trained to practice tissue sparing cancer removal. The more normal tissue that is preserved, the more natural the reconstruction can be. The reconstruction should be done by an ASOPRS trained oculoplastic surgeon. This is not something that should be done by a general plastic surgeon using frozen section control. Please understand that you have a choice who you see for care. Don't get care with surgeons who do not want to see and take care of you after surgery. Especially with eyelid reconstruction, on going eye care is needed in case the eye becomes irritated. Oculoplastic surgeons are board certified ophthalmologists with fellowship training in eyelid plastic surgery. My advice is to be assessed by the oculoplastic surgeon before skin cancer excision and have them refer you to the Mohs surgeon. Generally they will have specialist they know who are comfortable working around the eye.

Robert T. Buchanan, MD (retired) · Answer

It is impossible to comment intelligently on what you have been told by whoever you spoke to except to say that reconstruction of the lower eyelid takes significant expertise in the surgery and, occasionally, the post operative care so you need to make sure that the surgeon will be available postoperatively. I prefer a Moh's surgeon to remove the lesion so it can be done with the smallest margin possible. You then need a plastic or ophthalmic plastic surgeon to reconstruct, though there are now a very few Moh's surgeons who are properly trained and technically good enough to reconstruct the area depending on the resulting defect and exactly where the lesion is on the lower eyelid. Make sure whoever you choose for the reconstruction has vast experience in reconstructing this area. If everything goes well you can expect a relatively rapid recovery with return to most normal activities within a week. The most common problems are dry eye and persistent swelling. Most good surgeons will use berried sutures that will last at least 6 months for most of the closure and skin sutures that should be left in no longer than 5-6 days. Bruising will last several weeks but can be covered with make-up and a good sunblock a few hours after the skin sutures are removed.

What are realistic post-op care expectations following eyelid surgery for skin cancer & reconstruction?

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