What can improve my Mohs surgery in cupid's bow area? (Photo)

The Cupid's bow area of the upper lip is one of the most difficult areas to repair following a procedure like Mohs Surgery. With so many "special" borders (2 philtral crests that are elevated, the Philtrum itself, which is depressed and the cutaneous vermillion border, which is multi-curved), it is extremely difficult to obtain a superior cosmetic result. While a skin graft might best fit the bill if the crests still remain, finding a donor site that matches in color and texture may be very close to impossible. If any of the border has been crossed, resulting in a jagged border, normal vermillion would have to be sacrificed to straiten it out and this could lead to an upturn of that portion of the lip resulting in a snarl-like appearance. In order for a flap to work, there is seldom enough tissue in donor sites of the adjacent upper lip and, if there were, the flap placement would very likely obliterate one or both of the philtral crests. Using a vascular based pedical flap from a remote donor site would be a 2-stage procedure with 10 to 14 days between stages and then the color and texture match might pose a problem. And, understand that there is no guarantee that either a graft or a flap will take, particularly if you have a smoking history. Laser resurfacing may soften the look of the border of the graft and the native tissue, but I wouldn't expect more improvement than that.I think you can better understand the difficulty a surgeon faces in considering repair of the Cupid's bow area. However, there is always hope. I would strongly suggest you see a fellowship - trained Facial Plastic surgeon. Such a person is commonly a board certified Plastic or Otolaryngologic Surgeon who has had a year or two of additional training in facial reconstruction. One such surgeon may be able to handle your problem or know who to direct you to. Some Facial Plastic Surgeons concentrate their skills on a single anatomic area of the face. Finding one who is  an upper lip expert is your best bet. Good luck to you.