Puffiness After Mohs Surgery

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?

Doctor Answers 13

Skin cancer removal and postoperative care - Los Angeles

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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

Swelling / Puffiness after Eyelid Mohs Reconstruction

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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!

W. Thomas McClellan, MD, FACS
Morgantown Plastic Surgeon

Puffiness under the eye after Mohs surgery

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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.

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Puffiness near the eye after skin cancer surgery

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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.

Swelling normal after Mohs reconstruction

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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

Puffiness 5 weeks after reconstruction can be normal

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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.

Chris Thiagarajah, MD
Denver Oculoplastic Surgeon

Will flatten out

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   While I am not a Moh's surgeon, I have certainly referred numerous patients for this treatment. One of the things I have noticed is that many patients look terrible if seen a few weeks after their surgery. The area is puffy, red, and swollen.  However, when seen a few months later the wound has healed remarkably well and in nearly all occasions there has been an excellent cosmetic result. 

   Be patient.

Arnold R. Oppenheim, MD
Virginia Beach Dermatologist

Puffiness after Mohs Surgery normal for 2-3 months

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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

Puffiness after Mohs surgery

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It is not uncommon particularly around the eye to have puffiness after surgery. However, this should be self limited. Puffiness should resolve. If it doesnt resolve and it is cosmetically bothersome, then I would suggest that you first discuss with your Mohs Surgeon . If he is unable to help resolve the puffiness, then I would suggest you discuss this with a plastic surgeon. The puffiness is typically not indicative of a cancer recurrence but is more indicative of a healing issue related to the trauma of surgery. It is a cosmetic issue most of all.

Steven Hacker, MD
West Palm Beach Dermatologic Surgeon

Swelling and puffiness normal for many weeks after Mohs surgery

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In general, do not worry too much about some puffiness under the eye area after surgery, Mohs or otherwise. The early phase of healing lasts a month, and by 2 to 3 months there should be significant improvement. By 6 months even better, and by 12 even better. But truthfully, scars improve all the time indefinitely and the body wants the tissue to return to its natural state. It happens slowly over time.

I agree you may gently massage the area to help speed the smoothing. It definitely helps to relieve pulling and to get fluid out of the area. If after about 3 months you are still concerned with something being wrong, do not hesitate to go back to the surgeon and ask if anything can be done. There are some minimally invasive techniques that can help. And of course, on occasion, a surgical scar revision may be what's needed, but this is very unlikely.

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.