Is it possible to correct my Mohs incision scar?

Question

I'm devastated by the "butt" appearance at the tip of my nose now. I had a really smooth round tip to my nose and now it has a huge scar indention all the way down and around the tip. Even with time, I can't imagine this getting a lot better. I am ANXIOUS to have this fixed immediately. What would be some options for me. I am a month out from basil removal (only one tiny layer was taken) and then closed by a plastic surgeon.

Raffy Karamanoukian, MD, FACS · Answer

Plastic surgery scars require attention after surgery so that they remain cosmetically-appealing and barely noticeable. In our office, we use a protocol for scars that minimizes their activity in the 6-8 weeks after surgery. If you have late plastic surgery scars, you may also require laser and RF therapy to help reduce the longterm effects of the scarring. Keloids, hypertrophic scars, widened scars, red scars, and hyperpigmented scars all require scar modulation with topical creams followed by lasers and RF therapy. Topical skincare should be directed to a specific need, whether for pigmentation or hypertrophy and our office can guide you through the process to obtain the correct Plato’s Scar cream or Melarase cream for hypertrophy and discoloration. In terms of lasers, we would employ the vbeam laser for redness, Venus Viva RF, PRP microneedling, chemical peels, and Morpheus 8, fractional erbium, or fractional co2. All of these have their individual benefits. Most of all, we recommend you visit a solid plastic surgeon who understands surgical scar revision, laser therapy, and RF therapy for scars. 
 
Best, 
Dr. Karamanoukian
Realself100 Surgeon

Callum Faris, MD · Answer

Don't Panic! It is very early in the healing phase and it may improve with time. That being said it is a depressed scar at this stage and unless it improve scar revision is totally reasonable. A linear mid-line vertical closure on the tip is not a technique I often see. If the depressed scar does not resolve, dermabrasion or a formal scar revision would be suitable techniques. I hope this helps.

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Thank you for your picture. Your scar is young. It is only one months old. Scars can mature and change for the better over the course of a year. I would recommend only waiting at this point.

Jason Emer, MD · Answer

This can be improved with dermabrasion or laser resurfacing.  Sometimes after the laser procedure some microneedling and/or filler will help fine tune the scar.  It will get a lot better with these cosmetic options, but I suggest going to an expert.  Best, Dr. Emer.

Stephen Prendiville, MD · Answer

I am very sorry to hear about your experience.  Although 1 month is relatively early to completely judge, I can tell you that there are a number of very aesthetically effective local flaps that can be utilized in closure of nasal Mohs defects.  I wouldn't include linear mid-line vertical closure amongst those techniques. There is a possibility that dermabrasion may be helpful, but in certain circumstances, scar revision and irregularization is necessary. I recommend that you see a Facial Plastic Surgeon, Plastic Surgeon, or Mohs Surgeon with a lot of Mohs closure experience.

Stephen Mandy, MD · Answer

Your scar would definitely improve with dermabrasion or laser resurfacing with a fractional CO2 laser.  Before that I might suggest simply injecting a filler like Restylane to see if that would provide enough correction to make you happy.

Jody Comstock, MD · Answer

It is certainly understandable why you don't like your scar.  We treat skin cancer scars regularly in Tucson, Arizona.  I always start with having a patient wear a silicone patch at night for two weeks.  You can simply purchase a Scar Patch System at a local drug store and have it adhere with the tape that is included in the box.  We start with a non-invasive collagen stimulating laser and possibly a laser to remove red (broken blood vessels) every week to two weeks.  We often see marked improvement with this.   After 2-3 laser treatments we assess the status of the scar for broken blood vessels, redness, brown and texture changes.  At that point we may do the new laser Resurfx, deeper CO2 laser and/or dermabrasion.  Once the area has healed we determine if a filler is appropriate to completely even out the texture.  The technique of injecting the filler also helps stimulate collagen.  If you have the area injected, make certain it is someone who is a master injector to avoid any complications.  Good luck.

Robert S. Schmidt, MD · Answer

Hi there. Sorry to hear about your skin cancer. This scar can ABSOLUTELY be improved. I would start with dermabrasion. This is a short procedure that can be done in the office. Your doctor would numb the area, then use a little sanding tool to help to blend the scar in with your surrounding tissue. That can be done immediately- you don't have to wait. Initially the area would look like you had a rug burn, but it goes away after several days. If that didn't work, you still have options. Putting a little filler in the depressed areas could help to raise them. Depending on how things go, you can consider a surgical scar revision about a year following your initial surgery. The bottom line is this: you will always have a scar there, but you don't need to have THIS scar. Good luck!

Stephen Weber MD, FACS · Answer

The good news is that your scar can be significantly improved. You're still very early in the healing process. However, your scar does appear widened and depressed and this likely won't improve on its own. Laser resurfacing or dermabrasion (not microderm at a spa) can be very helpful and I will typically start this treatment as early as 6 weeks. For nasal scars, I am partial to dermabrasion as you can significantly smooth scars. A formal scar revision, if necessary, would need to wait at least 6-12 months. I hope this information is helpful for you.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

Darryl J. Blinski, MD · Answer

Best to seek IN PERSON opinions. I might try micro needling with PRP infusion. Dermabrasion is also another option...

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