Reconstructive Surgery after Mohs

Reconstructive surgery after Mohs surgery is an essential component for restoring both appearance and function, particularly when treating skin cancer in sensitive or prominent areas such as the face, ears, neck, and hands. At Palo Alto Dermatology Institute in Palo Alto, California, our nationally-recognized Mohs surgeons provide comprehensive, local anesthesia options tailored to each patient’s needs to achieve optimal aesthetic and functional results.  Our lead Mohs surgeon Dr. Morganroth, a fellowship-trained and board-certified Mohs surgeon, has performed over 30,000 reconstructions following Mohs surgery and trained numerous dermatologists and facial plastic surgeons in his techniques.

Reconstructive surgery after Mohs surgery is typically performed immediately after cancer removal or as a staged procedure, depending on the patient’s specific needs. The surgeon will evaluate the surgical site, plan the best approach, and discuss the details with the patient to ensure an understanding of the process. In some cases, combining multiple techniques, such as using a local flap with a skin graft, may be necessary for optimal results.  All procedures are performed with local anesthesia for maximum safety and convenience.

There are typically a variety of options to repair a skin defect following complete removal of the skin cancer with Mohs Surgery.

1. Some defects will heal well with acceptable scarring by allowing the wound to heal on its own with simple wound care consisting of topical antibiotics and light bandages. This is called granulation. Granulating wounds can take weeks to months to heal.  Common areas for granulation include the scalp, lower extremities, ear and inner corner of the eye.
2. Primary Closure: In cases where the defect is small or the skin is loose, primary closure may be used. This technique involves pulling the edges of the skin together and suturing the skin with two layers of sutures. This results in a clean and fine line that generally heals well with minimal scarring.
3. Local Flap: A local flap uses nearby tissue to cover the surgical site. This tissue remains partially attached, maintaining blood supply, and is then carefully repositioned through rotation, advancement or transposition to cover the defect. Local flaps are particularly useful for reconstructing areas with limited mobility, such as the nose or eyelids, and often blend seamlessly with the surrounding skin. Flap scars are typically geometric shapes and provide some of the best cosmetic results on noses, lips, eyelids, scalps, ears and other areas.
4. Skin Grafts: For moderate to large defects, skin grafts are an effective option. This involves taking a thin layer of skin from a donor site (usually from behind the ear, the eyelid, or neck skin) and attaching it to the wound. Grafts are especially helpful when the surrounding tissue is insufficient for a flap or primary closure.
5. Cartilage Grafts: In certain cases, when Mohs surgery affects areas where cartilage plays a structural or aesthetic role—such as the nose or ear, cartilage grafts may be necessary as part of the reconstructive process. Cartilage grafts add support and stability to the surgical site, helping maintain the natural shape and function of the affected area. The Palo Alto Dermatology Institute’s team of Mohs surgeons may recommend cartilage grafting in reconstructions where structural integrity and contour are essential.

Healing and Recovery

Recovery after reconstructive surgery varies based on the complexity of the procedure and individual healing characteristics. For minor procedures, healing may take only a few weeks, with most patients able to resume normal activities relatively quickly. Complex reconstructions may have a longer recovery period with additional follow-up appointments.

During the healing process, patients can expect some initial swelling, bruising, and discomfort, which typically subsides within the first two weeks. Adhering to post-operative care instructions is critical, including keeping the area clean, avoiding direct sunlight, and following any prescribed medication or ointment regimens. Our team at Palo Alto Dermatology Institute is committed to supporting patients throughout the recovery phase to ensure proper healing and the best possible outcome.

The goal of reconstructive surgery following Mohs surgery is to restore the patient’s appearance and functionality in a way that looks as natural as possible. Palo Alto Dermatology Institute’s board-certified Mohs surgeons use their expertise in advanced reconstructive techniques to provide personalized care, helping each patient achieve a comfortable and confident recovery. Through a thoughtful approach tailored to individual needs, we strive to support every patient on their journey toward healing and restored well-being.

For more information on reconstructive surgery after Mohs surgery or to schedule a consultation, contact Palo Alto Dermatology Institute in Palo Alto, California. Our compassionate team is here to guide you through every step of the process.