Whether you have just been diagnosed with a skin cancer or are considering your options for Mohs reconstruction surgery, you want to find a reconstructive surgeon with experience and vision. Often these cancers involve very sensitive facial areas like the lips, eyelids or nose. Removal of these cancers will result in a hole in the facial skin and disfigurement of natural features. Ideal Mohs reconstruction will preserve function and restore a natural appearance with well hidden scars.
Many new techniques have been developed to deal with these defects, including skin grafting and complex facial flaps. Because each region of the head and neck presents its own challenging and unique anatomy, Mohs reconstruction surgery demands a skilled specialist to preserve functionality and restore a patient’s natural appearance. Dr. Compton has done over 1,000 nasal and facial Mohs reconstruction surgeries including flaps, skin grafts, and scar revisions.
Patients should be seen by Dr. Compton before the malignant lesion has been removed to coordinate the removal and reconstruction to be the most convenient for the patient. Dr. Compton typically performs Mohs reconstruction surgery the day following the Mohs surgery, although for some patients, the surgery is done on the same day. On larger cases that require general anesthesia for the removal, Dr. Compton will generally perform the resection and reconstruction in a single procedure in the operating room working with the hospital pathologist to ensure that the entire cancer is removed.
Dr. Compton’s artistic eye will help to hide the incisions from the Mohs reconstruction as best as possible in the natural lines found in the face. He knows that hiding incisions in the natural creases and wrinkles prevents the eye from seeing them. The face is seen by the observers eye as multiple areas of light separated by shadows subunits with lines between them. These subunits are areas of light and shadow that divide the face. The edges of these facial subunits form ideal places to hide scars as the observer’s eye will naturally see a line in these areas. The most visibly obvious scars violate these facial subunits and the eye is naturally drawn to the irregular facial subunit. While not always possible, ideal incisions should be hidden in transition zones or natural facial wrinkles to hide from the casual observer.
Well placed incisions still require meticulous postoperative care including twice a day cleaning with peroxide to remove the crusting and application of a petroleum based ointment like Aquaphor. Suture removal should occur between 5-7 days after surgery on the majority of facial Mohs reconstructions. Cleaning with peroxide and applying ointment should be continued until the skin has healed closed (stops crusting). Following the complete closure of the incision a scar management system should be employed for 3 months. The most well studied and effective scar management strategies include silicone sheeting application for 24 hours per day. While extremely effective, this is not realistic for facial scars as these are difficult to keep attached and visibly obvious. Another very effective scar strategy is silicone based scar cream like Biocorneum. This scar cream is only available through a physician’s office and is extremely effective. It is easily applied to the scar twice a day, dries clear and while difficult to see can easily be covered with makeup if desired. During the first 6 months, a scar must be kept out of the sun as sun exposure can permanently discolor a scar. Biocorneum includes SPF which makes sun protection quick, easy and included in the same product. Contact the office or discuss with Dr. Compton for more details.
After the initial Mohs reconstruction surgery has healed, many things can be done to help further camouflage scars and enhance overall appearance and function. Such procedures include scar revision, dermabrasion and laser resurfacing. The goal is to have a scar or reconstruction that does not draw attention to you as you carry out your daily activities. In most instances this is possible.
After successful Mohs reconstruction, you will need to be followed by a dermatologist for evidence of any new skin cancer or other suspicious lesions. Depending on your skin type, this may mean visits once or twice a year. Keep in mind, the earlier skin cancer is diagnosed and treated the smaller the defect will be. If you have concerns about a suspicious mole or spot on your face or neck, you should be evaluated by a dermatologist specializing in Mohs surgery. To learn more about skin cancer and Mohs surgery, visit:
In some cases patients are referred by the Mohs surgeon but in many cases the patients select there own reconstructive surgeon. Make sure you have a surgeon who specializes in facial reconstructive surgery to handle your sensitive facial Mohs reconstruction.
Get in touch with Dr. Compton by calling
(248) 855-7530 or fill out the contact form below.
"Like most people I was worried about an unnatural look after having plastic surgery, but the subtle changes that Dr. Compton provided, made a big difference in what I saw in the mirror. I have more confidence now as I am no longer thinking about my problem areas. I am very happy with the outcome, thank you Dr. Compton."