Is this swelling or a trapdoor scar? (photo)

Question

Had Mohs done 7 weeks ago. The side of my nose still is swollen, even outside the scar line. Is this swelling or a trapdoor scar? I asked about steroids at 4 weeks and the plastic surgeon said it would go down. I just don’t feel like this is the case.

Raffy Karamanoukian, MD, FACS · Answer

Moh’s surgery on the face often requires surgical repair and reconstruction to reapproximate the skin edges. Flaps or direct closure techniques are used. It is important that you optimize scar healing during this phase in order to reduce longterm scars. For red scars, we use Vbeam laser, followed by fractional laser for scar topography and contour. We recommend Plato’s Scar Serum twice daily for the immediate postoperative period. Fractional laser is safe for scar laser therapy. 
There are treatments for swelling and edema of the scars. If there is residual sutures or edema, we advise you to follow a scar treatment protocol that can minimize the time to recovery. Our office specializes in scar revisions for Moh’s surgery. 
Best, 
Dr. Karamanoukian
Realself100 Surgeon

Sean McGuire, MD · Answer

Hi! 
I don't think it is a trapdoor scar because it is puffy outside of the scar line and from the provided photos.  Essentially two possibilities remain:
1)  It is prolonged post op swelling, which can resolve with time.  But if does take a while!
2) The flap itself may be too thick for the area, causing the appearance of prolonged swelling.  Based on the scar line and location, this is fairly common but frustratingly tough to predict when it will happen (I'm assuming a lot from the photo and visible scar)
So options to manage it - 
1) Steroid can help, but I often wait 6-8 weeks beforehand because doing it too early can cause unwanted skin thinning.  
2) Scar massage - sounds weird but really works by pushing out any collected fluid.  To do it, rub the puffy firmly area for 5 minutes 5 times a day.  Some people use moisturizer to make it more comfortable, but isn't necessary.
3) Scar revision - which can happen down the road.  I often wait 6-12 months after surgery before revising because the body heals very well given time.
Of course this is only on the info provided, so please consider in person evaluation first!

Is this swelling or a trapdoor scar? (photo)

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