Is puffiness after Mohs Surgery normal?

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 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

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.

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.

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!