Does my eyelid post MOHS surgery look normal? (Photo)

Question

I recently had MOHS reconstruction surgery (hughs flap) on my lower eyelid due to basal cell carcinoma, approximately six months ago. The lower lid is still quite thick and red and I was wondering if it will settle more and the redness will fade? I am quite unhappy with the results and was thinking of seeing another surgeon to have further reconstruction done as I am 26 and this has ruined my confidence. Do you think additional surgery could fix this?

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

Amy Y. Paul, DO, FAAD · Answer

It is still too early to tell how the final healing will turn out, but I would venture to say you will probably be pleased if you can be patient and allow the area to heal fully before taking any additional steps.  I have many, many patients that have had extensive Mohs repairs of the eyelids and I have not in 13 years of practice had anyone I know of need revision for any functional or cosmetic reason.  It takes a scar a full year to remodel and eyelids do tend to heal faster than other skin.  Try and follow your surgeon's post-care instructions and keep your follow up schedule with them so they can advise you best in person.  You can always get a second opinion, but I doubt another surgeon would want to operate this early post repair, unless you were having trouble closing your eye or something.  Best of luck!

Sean McGuire, MD · Answer

Hello - 
  Quick answer - it has a good chance of settling down further with time.  I would give it another 6 months - a full one year from the surgery - until pursuing revision.
 Longer answer - Based on the provided photos, it appears that the surgical site is still healing.  
  Surgical scars in areas with high vascularity - such as the eyelid - tend to hold onto redness for a long time.  It is really a double edge sword, because the same vascularity is what allows eyelids to heal very well long term. 
By definition, a Hughes flap in and of itself cannot be thicker than the donor eyelid, but it would be useful to know what was done to repair the front half the lid.  Was there another flap or a skin graft done as well?In general, there are modifications that can be made, but I always recommend allowing completion of the natural healing process (which can take about a year) before revising a scar unless there is a significant complication.  I would predict that the redness will fade, as well a majority of the excess fullness, but everyone heals differently and there is some variability.

I hope that is helpful information!  Please let me know if you would like to discuss further.

All the best, 
 Sean

Toby Nelson, MBBS, BSc, FACMS - Account Suspended · Answer

The Hughes flap has taken well. The redness should fade away within the first year. A revision could be consider after this point but any further surgery may also lead to redness for several months

Does my eyelid post MOHS surgery look normal? (Photo)

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