Mohs Surgery Scar on Nose

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. 

Thank you for the question. You have a depressed wide scar on the nasal bridge. Dermabrasion may help level off the step off, but it will not improve the widen scar. If simpler techniques fail to give you the improvement you wish, I would suggest a scar irregularisation technique, 1- to the make the scar thin and 2- to break up the long linear scar on the nose. The exact technique used would depend upon how much skin laxity you have on the nose. I hope this helps. If you wish for more information I would direct you to this book chapter - Chapter 34 Scar revision, Book Title - Facial surgery : plastic and reconstructive - Authors - Faris, Vuyk. I hope this helps.

After the wound has healed in the first few weeks, the best methods to treat scars are massage and silicone ointments (such as Biocorneum or ScarAway).  the scar is not stable until about 8-12 months after surgery.  I recommend these treatments for at least this long. If there is a contour deformity after a year, a surgical "touch-up" can be performed.  Lasers can help as well.

Our office specializes in scar revision and your textural and colored scar can be improved with a combination of treatments including laser, IIT, ablative laser, and topical application of Plato's Scar Serum. Best, DR. Karamanoukian 

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.

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!

Obviously, it is impossible to have a skin cancer removed without some form of scar.  However, the scar is somewhat depressed and wide on you nasal tip and may benefit from scar revision followed by Dermabrasion.  As was previously mentioned, any subsequent procedures always carry the risk of making the scar worse.

You appear to have some textural changes that are wider than the original incision which is by itself a reasonable scar.

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.

Fractional C02 resurfacing can help smooth the texture although it wont be as smooth as before surgery.