Hematoma and swelling after Mohs surgery on forehead is causing terrible scarring results. Any recommendations? (Photo)

I had most surgery several months ago for cancer on my forehead. It resulted in a large hematoma which then caused the scar to heal with an unsightly indentation. My dermatologist recommended a scar revision. Once again, I had a lot of swelling and puckering around the stitching. Why didn't he use intradermal stitching instead? Is the standard practice to stitch on the outside? It seems on the fore head there would be a better method? Should I see a plastic surgeon before this heals?

Doctor Answers 2

Hematoma and swelling after Mohs surgery on forehead is causing terrible scarring results. Any recommendations?

I do quite a bit of closures for a Mohs surgeon in town here in Arizona. It is impossible for me to know what sutures were put beneath the skin if any without the operative note. Being that said, it is standard to put what we as plastic surgeons call deep dermal sutures then interrupted skin sutures externally like you have. Certainly a hematoma creates an angry environment for the wound and scar whereby the scar becomes very firm and swollen for several months. It will calm down over time. I do not usually revise scars for one year because it takes that long for scars to completely heal. They will remodel from 6 weeks up to month 12. That is well documented in the literature. In that time period the scars will fade, become flatter and overall just look better. Everyone scars different so even the perfect closure may not look great on one person but perfect on another person. If I were you I would let this thing go for at least 6 months to allow the scar to calm down and soften and then maybe visit a plastic surgeon or your dermatologist if you trust them to look at it again. But, if I were you I would not try to revise this scar any longer until some time has passed to allow it to heal. It takes a LONG time so you have to be patient. It will not look good overnight or even in a couple months. And, by the way the puckering is usually from placement of the deep dermal sutures and goes away after several months when the sutures dissolve beneath the skin. That is when it flattens out. I hope this helps you!

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Stiches from Mohs and scar revision

There is intradermal stitching under there as well as external sutures, which is the way it needs to be done. You can see a plastic surgeon if you'd like but a big part of Mohs surgery (assuming you went to a Mohs surgeon and not just a doctor who does Mohs - there's a big difference) is training in closures for cosmetic purposes. "This answer has been solicited without seeing this patient and cannot be held as true medical advice, but only opinion. Seek in-person treatment with a trained medical professional for appropriate care."

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