Mohs Surgery on Nostril: Should I let it heal on it's own (and what would scarring look like) or have plastic surgery? (photo)
Doctor Answers 5
Often when one consents patient pre MOHS excision fro reconstruction on the nose you are consented for the need for a number of stages and flaps because one cannot predict the size of the defect. I do not see how it would take at max 2 stages to reconstruct this and in my experience this is reconstructable in one operation. The wound will be healed much quicker than leaving to heal by secondary intention.
For a defect this small a small local flap would give the best result and it is likely that this could be reconstructed in one stage. I would get a second opinion if your PS has seen this defect and is advising the need for 4 surgeries.
Give yourself time to heal. Then see.
Keep the area moist with an ointment such as Vaseline or Aquaphor at all times. Keep a small band-aid over it. It will heal by hopefully 4-6 weeks, and it will continue to fill in over several months. Sometimes it will completely fill in and the scar will be barely noticeable, especially in that area. Sometimes you might have a small divot, at which time you have filled in nicely and we can do a few cosmetic procedures to even out the divot.
Thoughts - I have had great success with microneedling, which encourages your body to create new collagen and it also smooths out the area. Filler (such as Juvederm or Belotero) can "plump" up the divot and stimulate new collagen. Finally, we could graft after you've grown your "sod," is the way I like to think about it - the best part is, the scar will be very small at that point and we can do a small graft.
You have choices. Let your body heal first! It's a bit of a commitment, but you deserve a chance to try and let your body do the work it was meant to do.
MOHS on Nose, Plastic Surgery Or Not
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Nasal defect after Mohs surgery
Reconstruction options include letting the defect heal on its own (secondary intention healing), a local flap or even a skin graft from a distant piece of skin. Your surgeon may refer to this as the reconstructive ladder.
Based on your photo and the short description you gave of a four stage procedure, I would assume that your surgeon is talking about a paramedian forehead flap, which in my opinion seems a bit excessive for the defect that you have.
Seek a second opinion from a fellowship trained dermatologic surgeon. This specific fellowship training ensures that they are very well-versed and competent in reconstruction themselves, and they work closely with our colleagues in oculoplastic surgery, facial plastic surgery and plastic surgery to ensure that you get the best reconstructive result that you can get.
Thank you for this quesiton.
Without examining you, physically feeling the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of any treatments it is difficult to be comprehensive.
There is a reconstruction ladder. The lowest rung is secondary intention healing meaning local wound care and let your body do the work. Unfortunately, in this area these is risk of contracture and pulling your nostril up.
The easiest option is to borrow skin just above your collar bone and patch the hole. It is one stage and would give you a great result. You don't have to go to sleep for this and it can be done under local anesthesia.
The other options of surgery include more complex flaps and techniques which can give you a superior result, but are more involved.
The other consideration is the strength of the nostril. Sometimes cartilage grafting is necessary.