Two Months After Mohs Reconstruction, I Have a Growing Divot on my Nose and Lumps on the Bridge, Revision Normal?

Question

The plastic surgeon said the divot is where the cartilage needs to be shored up, and the lumps can be repaired with dermabrasion. Why aren't these procedures considered part of the reconstruction process? Medicare covers only that which is medically necessary. I would think that making repairs to an initial surgery would be an extension of a medically-necessary procedure. Isn't it pretty typical for surgeons to do follow-up tweaks?

Sonia Badreshia-Bansal, MD · Answer

Thank you for your question. After any surgical procedure, healing generally can continue to occur for several months until maturation of the scar and wound.  This is typically reached by about one year after a surgery. Without seeing a picture, it would appear that your wound was either partially reconstructed, or was allowed to heal by second intention healing (naturally and without closure).  This, depending on the size of the original location of the surgery and wound, and depending on the location, is many times perfectly acceptable.  I would not make a determination regarding the end-wound or scar appearance for a while longer, as certain wounds heal up perfectly well with time and local skin care.  I would recommend continuing follow up visits as scheduled with your surgeon, and if a scar revision appears necessary, make this determination together with him/her.  Generally, because post-surgical wounds continue to heal for up to a year, scar revision would likely not be performed until this time. I hope this helps.

Raffy Karamanoukian, MD, FACS · Answer

A cosmetic result is attempted during any reconstruction. Discuss the nature of the cosmetic improvements with your surgeon and discuss whether they are feasible as cosmetic treatments in the early or late phase. Once you establish the feasibility, you may then want to discuss whether these are worth the cost. Raffy Karamanoukian, Los Angeles

Omar Ibrahimi, MD, PhD · Answer

Revisions for reconstruction of skin cancer defects are not always covered by insurance plans because the insurance company (not the docs) deem it as medically unnecessary. As a practice though, I usually do not charge my patients for minor things like dermabrasion to help improve the cosmetic appearance of the scar but this is a variable practice.

F. Victor Rueckl, MD (in memoriam) · Answer

What is deemed important by the medical insurance world, and what is deemed important by physicians, are not always the same. Insurance says that the cancer needs to be removed and the area reconstructed as best as possible during that stage of the procedure, and any alterations after that are considered cosmetic, if there are no further cancers there. It's not a fun world trying to balance the two, but speak to your doctor about costs and fees. I do many secondary procedures and "tweaks" as you call them, and I can find ways to make the costs as minimal as possible.

Two Months After Mohs Reconstruction, I Have a Growing Divot on my Nose and Lumps on the Bridge, Revision Normal?

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