Numbness and Scarring After Mohs Surgery

You have a healthy anxiety about the appearance of your nose but surgery wounds and scars take more than a year to improve.  Numbness quite commonly improves over time with the onset of tingling or "crawling" sensations that develop over many months.  The dorsal nasal advancement rotation flap you seem to have undergone is a very commonly performed reconstruction for nasal tip defects to minimize the distortion of the tip.  There is a displacement of skin from the neighboring nasal dorsum and lateral nose that is being used to distribute the tension and minimize deformity.  In this way, you will obtain maximal textural and coloration match compared with having had a skin graft (usually taken and completely removed from the skin in front or behind the ear and then sewn into the defect as a patch) which often develops a shinier and whiter skin color with loss of pores.  Your flap may benefit eventually with secondary procedures which can help the appearance look better but it is prudent not to rush in and treat early scars.  Sometimes, laser resurfacing, massage, special dressings, corticosteroid injections are used to make the flap look better.  Follow-up with your surgeon and see what they propose.

Hello! Thank you for your question! Numbness after any surgical
procedure is expected for several weeks to months following. As the
nerves to the area are traumatized and will then experience a temporary
neuropraxia, a transient loss of nerve conduction. This usually
resolves over the next 6-12 weeks, but depending on the procedure
performed, sometimes much longer. Typically this should resolve by 1
year. As it goes past this date, the likelihood of the sensation
returning is small. However, it can take up to 2 years. If no return
from there, it is unlikely to return. It should be discussed that
persistent sensory changes may develop following any surgical
procedure.  It will take up to a year for scars to fully mature.  Be patient with the results - continue with scar treatment/scar massage as directed by your surgeon, as well as avoidance of UV light by wearing sunscreen or hat.  If after this time the scar is still not to your satisfaction, consideration for scar revision and/or laser, dermabrasion, etc. may be considered.  The usual signs of the nerves regenerating and neuropraxia
resolving is itching, followed by a burning sensation and then
occasional sharp, shock-like pains. These will be normal to experience,
and actually a promising sign. Usually, normal sensation returns, but
is is also possible to have decreased sensation or even increased
sensation to the areas affected. Re-educating nerves postoperatively is
often helpful and will allow proper instruction for the affected
sensory nerves - methods include using different textures to the
affected areas when showering, bathing, applying lotion, etc. If
bothersome, there are some medications that may be helpful, including
Neurontin for pain for hypersensitivity. You can try various textures
such as washcloths, loofahs, cotton sheets, etc. Massaging the areas is
also beneficial for the incision to make the finest scar possible. The
last place to regain the sensation will be directly adjacent to the
incision/scar as the nerves will make its way from the periphery to this
location. If continual pain arises, evaluation is warranted. After
ruling out other causes, one rare explanation may be that a neuroma has
developed and may require surgical excision. This is very unlikely
unless a large sensory nerve has been transected inadvertently during
the procedure. Hope that this helps! Best wishes!

It is not uncommon to have localized numbness after Mohs micrographic surgery. The good news is that  numbness typically resolves after 3-6 months as there are redundancy in sensory nerve endings. It helps to minimize numbness and scarring with steady circular massage in affected area 4 weeks after surgery, 10 times every 6-8 hours.