How can I reduce subQ scar tissue after MOHS reconstruction?

Scar tissue will respond to both steroid injections and massage. It will take several more months for you to appreciate the effectiveness of these therapies. I would hang tight for about 6 months to see how your tissues respond. If there is still some tightness and firmness to the scars, at that time you might do well with a small scar revision or z-plasty procedure.

Scarring is always a potential complication after Mohs and reconstructive surgery. When a skin flap is used for a surgical repair, additional swelling and "pin-cushioning" can add to the stiffness of the skin. I agree with the approach your doctor has already taken. Steroid injections and massage can significantly reduce scar tissue and make the skin much softer and more pliable. Often a series of injections can be required to get an optimal effect. One thing to consider is that you are only 1 month post-op. It can take the skin up to 6 months to heal completely, especially over the lip where swelling can persist long after surgery. If the injections and massage do not help in resolving the scar tissue, a number of lasers including pulse dye or V Beam laser and fractionated CO2 laser have been reported effective in treating scar tissue. Finally, surgical scar revision might be an option. Before pursuing these more aggressive approaches, I would discuss the outcome with your physician and see if they feel any of these other therapies might help you.

Because your skin cancer was located in such a critical area even a small cancer might need a large reconstructive procedure. The good news is that scar tissue will continue to mature with time and this should get better and better. Steroids can help soften an overactive scarring response. Lasers can also sometimes help reduce the appearance and soften scar tissue. Ask your Mohs surgeon about these options.