Lump after Mohs surgery, will it flatten? (Photo)

Question

My concern is the lump on my nose above the skin flap. Is it still going to flatten? I know it's too early to tell but I want to know what I can do or can be done. Photo taken 5 weeks after surgery. Is my skin flap healing well? Thank you for your help.

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

Tarek M. Fakhouri, MD · Answer

Hi Deryl,
Thanks for the great question! When the skin heals after surgery scar tissue can form. Usually this happens between 4-6 weeks after surgery. The contraction of the skin from scar tissue can make a skin flap puff up and look like a pin cushion. Typically this will not flatten on it's own. You need to see a Mohs surgeon to evaluate the scar and inject medication into the scar to flatten the flap and stop the formation of scar tissue.
When I perform my flap repairs I am extra careful to use surgical technique that prevents pin cushioning from happening. It is critical that the Mohs surgeon plans the flap properly and utilizes a wide undermining technique so that scar tissue will not distort the flap as it heals.
Stay positive, there are things that can be done to help your flap heal better!
Take care! -Tarek

John Louis Ratz, MD · Answer

The "lump" you are experiencing in your flap repair is called a "trap door" or "pin cushion" defect. It can occur in small flaps and in flaps under tension. There are several options. The flap can be elevated so the underlying scar tissue can be removed and the flap replaced. With this procedure, there is no guarantee that you won't have a repeat performance. Another option would be to have the defect injected with Kenalog (a steroid) at a concentration of 40mg/cc. While this may help flatten the defect, several injections at 4 to 6 week intervals might be necessary. A final option would be to have CO2 laser resurfacing of the defect. This would actually be more of a sculpting procedure such as is done for another nasal condition called rhinophyma. Results with this procedure can be excellent but require experience in the physician performing the procedure. Hope this helps. Good luck.

Lump after Mohs surgery, will it flatten? (Photo)

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Lump after Mohs surgery, will it flatten? (Photo)

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