MOHS Surgery

Reconstruction

Candidates for MOHS Surgery Reconstruction

You may be a candidate for facial reconstruction with Dr. Ramachandra if you have been diagnosed with a biopsy-proven non-melanoma skin cancer (NMSC) on the face, particularly in delicate or cosmetically sensitive areas such as the nose, lips, ears, or cheeks. These types of tumors are removed by dermatologic surgeons using the MOHS technique, a specialized process by which NMSC is removed. 

After tumor removal is completed with the Mohs procedure, the wound is most often closed immediately by the Mohs surgeon. However, if the wound is too large or complicated for repair in the Mohs surgeon’s office (or if the patient prefers), a pressure dressing is applied, and the patient is sent to a reconstructive plastic surgeon such as Dr. Ramachandra. Usually the dermatologist can determine if a wound will be extensive/complex beforehand, and the patient is able to consult with Dr. Ramachandra before the cancer is removed. Sometimes, however, the defect can be unexpectedly large, and the patient arrives for consultation with the defect.

Results and Goals of MOHS Surgery Reconstruction

Dr. Ramachandra restores form and function after skin cancer removal, with careful attention to facial aesthetics, symmetry, and movement. A defect in a particular location can require different reconstructive approaches depending on a person’s skin quality, pigmentation, texture and prior surgery. Dr. Ramachandra tailors each repair to the specific wound and to the individual, aiming for a natural long-term result. While all surgical wounds heal with scar tissue, Dr. Ramachandra applies meticulous technique to conceal scars whenever possible. Most patients find that the appearance of the repair continues to improve over time, with little or no need for further revision.

MOHS Surgery Reconstruction Procedures

Reconstruction after MOHS surgery can be performed on the same day of the cancer removal, or within a few days. The type of repair depends on the location of the tumor, its size, and how far it extends beneath the skin. A patient's preferences and other medical issues may also play a part. Unless a decision is made to let the wound heal by itself, the following techniques are used for reconstruction:

  • Stitching the wound closed

  • Skin graft (skin is harvested from another part of the face or neck and sewn into the wound)

  • Single stage skin flap (skin is repositioned from a nearby area)

  • Multiple-stage pedicled flap (skin and soft tissue are transferred into the wound while still connected to a blood supply; 3-4 weeks later the bridge of tissue is divided and the defects are closed).

Recovery from MOHS Surgery Reconstruction

Recovery following Mohs reconstruction depends on the size, location, and complexity of the repair. Most patients experience mild swelling, bruising, and discomfort for several days. Sutures are typically removed within 5–7 days for delicate areas such as the eyelids or lips, and within 7–10 days for the nose, forehead, or cheek. To reduce the risk of bleeding or wound complications, patients should avoid strenuous activity, heavy lifting, and bending for about a week. Scars continue to mature and fade over several months. Consistent sun protection is essential to support optimal healing and minimize long-term discoloration.

Risks of MOHS Surgery Reconstruction

As with any surgery, risks of Mohs surgery reconstruction include bleeding and infection. Although rare, its specific risks include nerve damage, skin grafting that does not “take,” and permanent scarring.