Is puffiness after Mohs Surgery normal?

Question

I had Mohs surgery done on my face just below the eye 5 weeks ago. There is still some puffiness in the area. Is this normal and if so, is there something I can do to relieve it?

Raffy Karamanoukian, MD, FACS · Answer

Swelling is usually normal after a surgical repair.  Speak to your surgeon to make sure the swelling is not related to any redness or infection. Raffy Karamanoukian, Los Angeles

William Ting, MD · Answer

You are experiencing normal course of wound healing after Mohs micrograophic surgery. Hypertrophic scar change is partially due to skin tissue reaction to the buried suture material and should improve over time. You should perform scar massage 10x 3-4 times a day, starting a month after sutures have been removed. After a couple months, if there is significant puffiness, your Mohs surgeon can perform intralesional steroid injection to soften the scar tissue.

Jeffrey Cone, MD · Answer

The eyelids are a bit more prone to swelling than the rest of the face, and a small amount of persistent puffiness is common, even after 5 weeks.  This is because eyelid skin is thin (revealing everything underneath) and surgery can disrupt the lymphatics of the area (leaving more fullness).  At two weeks, we start scar massage and silicone therapy, and occasionally add compression tape.  Keep in mind that scars take 12 months to fully mature, so time will help further.  Best of luck.

W. Thomas McClellan, MD, FACS · Answer

Puffiness following eyelid reconstruction is not uncommon. It typically resolves by 6 months as lymph flow improves. There are a number of maneuvers you can perform to assist in its resolution; cold compress, massage, head elevation and time.

	I dont typically use steroid injections as they can cause hypopigmentation (white skin) and fat atrophy (hollowing).

	One cause of puffiness around the eye can be redundant orbicularis occuli muscle or sub cutaneous tissue. This will not resolve with expectant observation and may require a debulking procedure. Another cause could be damage to the orbital septum and periorbital fat herniation which also may require a revision. If puffiness doesnt resolve after 6 months you could look into these causes further.

	Make sure you have close follow up with your surgeon and explain any concerns you may have.

	Best of Luck!

Laxmeesh Mike Nayak, MD · Answer

The area under the eye retains swelling for months after surgery in the area. Massage, pressure taping, head of bead elevation, salt restriction, and (especially) time are the best treatments.

M. Christine Lee, MD · Answer

It's normal to have swelling or puffiness around the surgical especially when it involves the eye area for several months after surgery. It helps to apply cold compresses for a few minutes several times a day. Vigilon or 2nd skin or a hydrogel dressing left in the refrigerator and then applied to the area might also give some relief. Try not to bend over and keep your head upright. A surgical wound is not 100% healed until after one year.

Andrew Kaufman, MD · Answer

Surgery near the eyelids and the lips tends to have puffiness for a longer period than other sites. This is related to the delicate lymphatic channels at these sites. It takes time for the lymphatics to recover in these sites and during that time there may be some puffiness. Make sure to follow up with the surgeon to assure there are no other issues, but this problem is likely going to be self limited and resolve in a few weeks to months.

Stephen Weber MD, FACS · Answer

Swelling or puffiness around the eye and anywhere on the face is common after reconstruction. This likely results from edema which is tissue swelling. This can also result from maneuver like skin edge eversion that result in better scars but in the short term can cause a ridge around the edge of the reconstruction. Massage is very helpful starting 2-3 weeks after reconstruction. Steroid injections can also be used very conservatively for hypertrophic scars. A visit to a facial plastic surgeon will likely reveal the best way to proceed but I would caution you to wait 6-12 months before pursuing revision. Most scars will mature and improve up to 12 months following surgery. Stephen Weber MD, FACS

Chris Thiagarajah, MD · Answer

After Mohs surgery, depending on the reconstruction especially near the eye, there can be swelling and healing that goes on for several months. 5 weeks is very early in the process. I wouldn't worry and let it heal for a good 5-6 months. Remember you probably had a hole that had to be fixed. Things need some time to heal.

Chad L. Prather, MD · Answer

Puffiness, or a raised scar, is very normal for 2-3 months after surgery. In fact, one of the principles of cosmetic reconstruction is to "evert" the wound edges, so it can actually be a good sign that the scar is raised for 6-8 weeks. It's not time to panic yet. 
Scars will normally remained firm and raised, but will flatten out after 8 weeks or so, depending on the thickness of skin and type of closure. Here are 2 things you can do to help:
1. Begin using silicone sheeting or silicone gel to the site for 8 hours per day or night for 2 months. While many products claim to work for scar improvement, silicone is one of the few that has shown benefit in studies
2. Masage the area several times per day for 30-45 seconds. This can be started after 4 weeks of healing. It's best to use a little hand or facial lotion, or petrolatum ointment, when doing this.
Your scar will improve without the above techniques, but they will help it settle faster.
Be well,
Dr. P

Is puffiness after Mohs Surgery normal?

Answers (14)

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