I had basal cell carcinoma on my nose, and I had Mohs surgery to remove it. The following day, I had plastic surgery to close it up. The plastic surgeon did a skin flap reconstruction from skin from my nose, and it pulled skin from my left eye. It's extremely tight and looks lopsided and makes my eye really tired. Will it loosen up and even out when the stitches are out?
Tight and Lopsided Skin Flap Reconstruction Results
Doctor Answers 11
There is a great art to performing skin closures after Mohs surgery. Regardless of who performs the closure, it does take some time for the skin to heal, and the swelling to go down. Immediately after surgical closure of the wound, it is not unusual for significant swelling to occur, distorting tissues, and sometimes causing a temporary pulling and tightness of the skin.
Fortunately, these changes dissipate over 1-2 weeks after surgery. Occasionally, however, it may take longer for the post-surgical changes to go away, sometimes as long as several months.
With that said, I always make it a point to see my patients a few days after surgery and I continue seeing them regularly as the healing progresses. At these visits, I discuss the surgical closure and ask the patient if they have any concerns about the cosmetic or functional outcome of the surgery.
Although a revision surgery may be performed to correct an unexpected surgical outcome, this is very rarely necessary, especially when the procedure is performed by someone accustomed to performing Mohs surgery closures.
I would encourage you to bring up your concerns to the surgeon at your post-operative visit. If none was scheduled, call the surgeon's office and ask to see the doctor to discuss this soon.
Without a photograph it is impossible to respond to you except in generalities. Reconstructing the nose with a flap (an island of tissue borrowed from next door and turned to cover the hole left by the cancer removal) is associated with swelling. Your surgeon fully understands these subtleties and I am sure that he considered post op swelling and tension when he/she performed the operation. Once the swelling subsides you will be pleasantly surprised.
A local tissue flap can affect adjacent tissue. Most of the cases will resolve once swelling subsides. Make sure you express your concerns with your surgeon to prevent any longterm problems. Raffy Karamanoukian, Los Angeles
Web reference: http://surgery90210.com/cosmetic-dermatology/27/skin-cancer.aspx
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The skin is surprisingly resilient and even the tightest wound closing after skin flap repair will loosen up nicely over time. Work with your dermatologic surgeon or plastic surgeon and start scar massage after agreed upon time after suture removal. Cortisone injection for hypertrophic changes or additional scar revision may be seldomly performed as needed.
Web reference: http://www.drwilliamting.com/Mohs_Surgery.html
I am assuming that you have seen a fellowship trained Mohs surgeon and a board certified plastic or facial plastic surgeon. All flaps do take time to "mature" and in trained hands will most often yield lovely results. The early healing phase requires some patience and faith on your part. If you have concerns with your plastic surgeons work, you need to ask them about it. Getting advice online will not help you since we cannot see the work and your surgeon will know better than anyone what was done and whether this is a normal good outcome or whether there are some issues that need to be addressed. Call them and find out today. Good luck.
Nasal reconstruction after Mohs surgery is tricky; the goal is for excellent functional and cosmetic results for years to come - not just for the first few days or weeks.
Sometimes, in order to get good long term results, reconstruction is more involved (ie, flaps and or cartilage grafts) than one might imagine (ie, simple sutures or skin grafts). The healing from these more involved repairs may take several months, but the long term results are worth it.
Give it time - follow up with your reconstructive surgeon as he recommends. If you are still dissatisfied at 1 year, revision may be appropriate.
Good luck!
Mike Nayak, MD
It will take time for your scar tissue to soften. However, sometimes a surgical lid ectropion occurs after repairing a skin cancer defect close to the eye. This should be followed and repaired by an oculo plastic surgeon if it is bothersome.
Most patients look pretty gruesome shortly after reconstruction of a defect left by Moh's micrographic surgery of the nose. Most of the time, the result improves dramatically. This, however, takes time. Too often surgeons get involved with manipulation of the wound healing process and create a bigger problem. Steroid injections and various adjustments should be done rarely.
Web reference: http://www.zubowicz.com
It is not uncommon to have some pulling on a flap after reconstruction. All wounds are different and reconstruction can be a challenge. Most flaps will look better and settle down over time. A flap can take as long as 6-12 months to fully mature. You best bet is to discuss this with the plastic surgeon and insure that he/she follows you closely to make sure you get the best result possible.
I appreciate your concern and worry regarding the pulled appearance after Mohs surgery. You should rest assured that it is not uncommon for nearby anatomical structures (lips, nose, ear, eyes) to look a bit pulled after reconstruction. Such effects generally settle out within 90 days or so. If it is persisting beyond 90 days, you should return to your surgeon for a re-evaluation.
Web reference: http://www.drclevens.com/face/mohs-procedure.html
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.
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