I had Mohs Surgery when I was 27 (8 years ago) to remove a large basal cell carcinoma from the tip of my nose. My scar runs along the length of my nose and is discolored, raised/depressed and my nose has a somewhat lopsided/chewed up appearance now. After surgery, I had one session of dermaplaning with some improvement to texture. What are the best scar treatment options for me and would I get better results from a plastic surgeon or laser surgeon? Thanks
Mohs Surgery Scar on Nose
Doctor Answers 14
Mohs surgery basal cell carcinoma nose 27 year old
Before anyone discusses revision of a scar for cosmetic reasons, please note that your photograph preoperatively shows a whitish flat spot. This type of basal cell skin cancer is usually an infiltrative type of pattern of growth so it doesn't look clinically typical and may spread for a wide area. It grows with little strands in different directions underneath the epidermis. In your current photograph, there again, is a white area which may represent scar from some tissue scabbing that you might have had in the acute postoperative period years ago, or this might indicate that there is persistent disease of that basal cell carcinoma. This must be thoroughly explored prior to embarking an revision of the scar. You may need a biopsy, taken appropriately of the right depth to show a pathologist the dermis so as not to get a false negative result if there is not enough tissue to see it. This will leave another scar present on the nose!
If a biopsy is done and the skin cancer specialist is confident that there is no tumor present clincially and histologically (under the microscope) then a precise scar excision and resuturing may improve the slight groove and mismatch of skin that often occurs in the thick oil-gland rich skin of the nose. This may result however, in a worse scar. Dermabrasion or Fraxel Restore laser done in a series of multiple treatments may improve the texture of the scar significantly.
As your skin came together from both sides of the nose it made the skin quite tight. Despite some stretching of the skin that develops over time after these closures, the pressure caused the cartilage of the lower nose to bow. You may benefit from a rhinoplasty to build up this profile and support the nasal tip better, especially if a scar revision is done by excision and reclosure that would make this even tighter.
I would agree with some of the other physicians that I would talk with your dermatologist before undergoing any scar revision to ensure that you do not have a recurrence of the skin cancer. If that is not a concern, I would suggest speaking with a facial plastic surgeon. Laser resurfacing can be useful but it may be that you need several kinds of lasers - one for texture and one for color. If you have significant texture irregularities, fillers or reexcision may be more appropriate. Dermabrasion is always another option. In person consultation is always the best option.
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Scar following mohs
Fractional C02 resurfacing can help smooth the texture although it wont be as smooth as before surgery.
Scar revision after Mohs micrographic surgery
While most scars after Mohs micrographic surgery is a worthwhile trade off in place of an insidious skin cancer such as basal cell carcinoma, it is reasonable to desire scar revision afterwards. Before resorting to additional surgical scar revision where the resulting scar may not be superior than the original scar, it may be helpful to undergo Fractional CO2 laser resurfacing as the texture of the scar can be improved and overall risk of getting another skin cancer in the area that is treated may be reduced.
Options for scar improvement after skin cancer surgery
The options depend on what degree of improvement do you want and what amount of downtime or healing are you willing to tolerate. Topical silicone sheets or additional dermabrasion might improve the final cosmetic results, but that tends to work best in the first year after surgery. The second option would entail excision of the scar and scar revision. This should be addressed by a doctor with a significant amount of training in nasal reconstruction, either a fellowship-trained Mohs surgeon, facial plastic surgeon or plastic surgeon.
Nasal scar revision options
As mentioned, the options include something simple like dermabrasion or something more formal like a scar revision (actually excising the old scar and more carefully re-approximating it).
Without examining you, it is hard to tell what those possibilities could be, but...if the scarring has caused the skin to be very tight, believe it or not, performing skin stretching exercises can loosen this and usually can make enough laxity to allow it to be revised with an improvement in the appearance. This can take months or (in some cases, years) before it is ready to be done safely.
Best of luck, hope this helps!
Demabrasion and/or CO2 laser best for nasal scars
As said before, anytime that you have surgery, you are going to get a scar. I agree with Dr. Prendiville that dermabrasion would be a reasonable thing to try for this. It looks to me like there was a slight step-off deformity (i.e. the two sides did not align exactly after closure). I think dermabrasion could help that, but as said before, there is always the risk of making things worse.
Nasal scar revision
There isn't any significant extra skin on your nose to use in a revision so just excising it will make it tighter and this isn't usually going to improve a scar. You don't look bad enough IMO to go to the nasal reconstruction flaps like a forehead flap but that is an option if you really hate the current state. Look these up for examples.