I had a BCC removed on my nasal ala with Mohs Surgery 6 months ago. A rhomboid flap was used to repair it. The flap has been raised from the beginning and my nose does not look symmetrical. The crease cannot be seen on the right side because of the elevated flap and there is also a bony protrusion just to the right of the tip that shows as a white bump. A shadow and pulled look shows along the bottom edge of the flap. No cartilage was added when repaired. Please offer suggestions. Thanks.
Revision Suggestions After Mohs Surgery Repair
Doctor Answers 5
Revision might be needed
Revision might be needed, but the flap may continue to improve with time. If you want to avoid further surgery, you may get some improvement with conservative steroid injections in the high areas or filler injections to the low areas. Seek the advice of a surgeon with lots of reconstruction experience. Good luck!
Revision after reconstruction
Nasal symmetry can be achieved by undergoing revision so that the missing groove can be sculpted to match the other side. It is a fairly straight forward procedure. It is difficult to appreciate the other changes on the photos provided so it is difficult to say what type of revision would be most appropriate. Importantly, scar remodeling takes place over the course of a year so the final result is likely to be more pleasing that what you are seeing right now. Meanwhile, raise your concerns with your surgeon so that you have a plan of action if you are not satisfied with the final outcome.
Multiple steps sometimes necessary for nasal repair
A rhomboid flap can be a great repair for the nose after Mohs surgery. Often it can be accomplished in one stage, but some flaps need additional steps to help get the best cosmetic result. Bulkiness, or "pincushioning", and blunting of the normal nasal groove is a common phenomenon experienced after rhomboid repair. Fortunately, with further revision, this can be improved and reduced. I would recommend seeing the physician who performed the repair first and ask if additional steps are necessary. If none are taken, a second opinion with a dermatologic surgeon or plastic surgeon would be in order.
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Talk to your surgeon
Many times surgical repairs will require revision to get an acceptable final appearance. It is not uncommon for rhomboid flaps to pincushion. Sometimes an injection of steroids can help flatten this out. In regards to your crease being gone, some times this has to be reconstructed as well. Your Mohs surgeon should be willing to do these revisions; if not, go see a plastic or facial plastic surgeon for consultation.
If you are unhappy with the cosmetic result of a surgical reconstruction, you should consult with a plastic surgeon and determine what options you have for revising the reconstruction. The surgeon will need to see you in person to give you the best advice.