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Esteemed Contributor
Posts: 6,583
Registered: ‎08-08-2013

Re: Mohs Surgery and Plastic Surgery Reconstrucion

@FastDogWalker2  How do you know you need to have pastic surgery reconstruction?  In May 2014, I also had a BCC on the tip of my nose (a tad off the tip) and at the consult, the MOHS doctor told me that "if" I needed reconstructive surgery, he would take some skin from either behind my neck or close to it.  But, at that time, he didn't  say anything about plastic surgery because they never know how much they are going to remove.  At least, that's what I remember.  I could be wrong.

 

Secondly, there is no general anesthesia because you are only in his chair for a few minutes and then you go to a waiting room, either to be called in again or checked out.  I was called back 5 times.  I was there for 6 hours.  Every time he takes some tissue out, he goes to look at it under a microscope and either "there's more" or he's finished.  The anesthesia consists of a shot close to the area (mine was the fleshy part of my cheek, right next to my nose and I didn't feel anything)  I think they numb the area first.  That's the least of it anyway.  I had "Versed" when I had cataract surgery.  With a Mohs procedure, you need to be awake.  I was able to close my right eye and watch everything he did, with my left eye.  (not a pretty sight, lol)

 

He ended up taking skin from right under my clavicle (about a 6" cut) and he fit it right into the opening he created in my nose, about the size of a postage stamp.  I had 20 stitches if you can believe that - five on each side of the "stamp".  There is definitely an "art" to the stitches.  It took him probably less than a minute and there are absolutely no scars.  I had to go back two days later to make sure the skin graft "took" and then, I think, a week later to remove the stitches.  The only annoyance was the changing of the bandage frequently.  I don't remember but at least every day and it's a very inconvenient place to bandage properly.

 

I should tell you that my Dermatolotist would have preferred it if I went for radiation instead of Mohs, just because it was my nose and you never know how it's going to look after they are done.  In my case, I should have done my homework.  I never would have gone for Mohs, knowing what I know now.  I had a "nose job" years ago and that was one reason my regular Dermatologist wouldn't touch it and recommended the Mohs doctor OR radiation.  I chose Mohs because it's over the same day but it also left me with a dent in my otherwise "perfect" nose, which is just now, after 3 years, starting to fill out.  When I went back to my Derm. he took one look at me, and said "I am soooo sorry".... Even he didn't expect an outcome like that.  He mentioned something about filling it in with Restylane, but sadly, he passed away very unexpectedly the following month.

 

There is so much more but I don't want to discourage you any more than I probably did.  Just, please, do your homework.  Ask questions.  Ask your doctor.  Google stuff.  Find out about radiation, etc.  Don't make any hasty decisions.  It's your nose and not everyone has the same outcome.

 

I also want to add that, in my case, there was absolutely no visable sign of any skin cancer.  I just felt a teeny pimple on the tip of my nose, which shouldn't have been there.  I told my Derm about it and he said "where is it?".  I had to put his hand on it.  He then took a biopsy and sure enough.  It was BCC.  When I went to the Mohs Dr., again, he said "what are you talking about?".  I said "here, feel it"..... He said "I can't see anything - I'll take pictures"..... LOL  I know, it sounds crazy but it's true.

 

I wish you luck in whatever you do and please report back and let us know the outcome.

 

P.S.  I I am allowed, I could post a picture of my nose, right after he stitched me up.  I know it's in DH's camera - just have to find it.  We have many.  DH was in the room and watched the whole thing.  He should have taken a video but we didn't think about it at the time.  At least, we got some pics of the "after".....

 

Sorry to have taken so long - but it is what it is.....  Again.  best of luck to you in whatever choice you make.

 

 

 

 

 

 

Trusted Contributor
Posts: 1,366
Registered: ‎07-24-2012

Re: Mohs Surgery and Plastic Surgery Reconstrucion

FastDogWalker2, I had Mohs more than 7 years ago on my forehead just below my hairline.  I remember them having to go back 3 times to get it all.  I have a very noticeable white scar with the flap shape about  1 1/2 inches long-jagged. I notice that people look at it when we are talking.  Try to wear bangs but they blow back sometimes. Feel like Frankenstein.  Not happy, and it was a Mohs/plastic surgeon who did it. I must scar badly ot maybe it was the location on my face.  Good luck to you. It is always wise to gather as much information as possible before doing anything.  Sounds like many others were fine.

Regular Contributor
Posts: 242
Registered: ‎07-02-2010

Re: Mohs Surgery and Plastic Surgery Reconstrucion

I also read about another less harsh treatment like another post mentioned in the form of radiation.  I think I would look into this before making a decision.

 

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Respected Contributor
Posts: 2,241
Registered: ‎12-05-2012

Re: Mohs Surgery and Plastic Surgery Reconstrucion

People have mentioned exploring other options. Here is my experience.

 

There are 3 or 4 types of basal cells. Mine came back 'Superficial' type and the MOHS surgeon wanted me to use topical chemotherapy on it.

I did and when I went for the recheck a 'Nodular' basal cell was uncovered which had not even been visible at all. Not uncommon I guess.

 

As I understand it only the Superficial type can be treated without surgery.

My Nodular lesion required MOHS. No plastic surgery.

Respected Contributor
Posts: 2,241
Registered: ‎12-05-2012

Re: Mohs Surgery and Plastic Surgery Reconstrucion


@kjae wrote:

FastDogWalker2, I had Mohs more than 7 years ago on my forehead just below my hairline.  I remember them having to go back 3 times to get it all.  I have a very noticeable white scar with the flap shape about  1 1/2 inches long-jagged. I notice that people look at it when we are talking.  Try to wear bangs but they blow back sometimes. Feel like Frankenstein.  Not happy, and it was a Mohs/plastic surgeon who did it. I must scar badly ot maybe it was the location on my face.  Good luck to you. It is always wise to gather as much information as possible before doing anything.  Sounds like many others were fine.


Have you thought about consulting a plastic surgeon. My sister in law was not happy with her MOHS scar (flap I think) and had it redone. She is thrilled with the results.