Is it possible to repair bumpy/pulled down lower eyelid margin after mohs reconstruction? (Photo)

These would be great questions to pose to your reconstructive oculoplastic surgeon, and perhaps you already have. For the defect you had from the skin cancer, your current result looks excellent, but it is reasonable to inquire as to whether there could be options for the things that you are noticing. Part of the answer depends on how long ago you had surgery. The defect in the skin from the cancer removal has caused some tightening of the eyelid skin below the eyelid margin that is rolling the margin away from the eye in the area of the cancer removal. If the surgery was in the last few months, even if you did nothing, you will still get improvement in the tightness of the tissue and the position of the margin and the bumpiness you notice. Thin or dilute soft tissue filler in very small amounts can be used as a "tissue stretcher" in the lower eyelid for a small amount of lid retraction. Sometimes this is combined with medications such as 5FU or steroids to modify wound healing. If it has been longer than a year, this may not be as helpful and then you have to consider whether surgery to try to release the skin along the margin leaving an open area to heal with upward traction on the eyelid like a tarsorrhaphy stitch for a week could help, or consider a tiny skin graft. This might help the eyelid roll back up and in, but the cosmetic results of a skin graft are not always predictable, and you could end up with something that you like less than what is there right now. The other issue that alters the appearance of the lid is some lash loss. The absent lashes that were necessary to remove as part of the cancer surgery create a highlight along the lid margin that adds to the perception that more eyelid is showing. Using makeup to camouflage the lash loss would help, or you could consider some delicate tattooing in just that area.

After a mohs procedure, even with optimal results, there can be slight pulling of the eyelid skin due to scar tissue formation. For the first few months after the procedure, I recommend using silicone scar gels in the area and massaging the scar (upwards) to allow the skin incision to relax. In addition, injections of anti-scar medication can further help you achieve your goal. In rare, more severe cases, surgery can be performed to improve the tightness in this area, however, this pulling sensation may resolve with time and conservative measures I discussed before. Take care and be well.