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Jacob D. Steiger, M.D.
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Boca Raton, FL 33432
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FACIAL RECONSTRUCTION

Reconstruction after MOHS Surgery

Warning- Some of the pictures below are graphic in nature





Skin cancers such as basal cell and squamous cell carcinomas are the most common forms of cancer in the United States. Unlike the rest of the body, the face is a focal point of attention that is not easily hidden from view. For this reason, many patients choose to have their surgical defects, created from skin cancer removal, repaired by a facial plastic surgeon.

There are many factors that need to be considered when repairing a defect created by the removal of a skin cancer. They include the location, size, depth, and extent of the defect. In addition to his expertise in cosmetic surgery, Dr. Steiger has extensive experience repairing facial defects created by MOHS surgery. He works closely with highly qualified MOHS surgeons in order to coordinate the best possible care for his patients.

Before and after photos of a forehead flap to the nose
Reconstruction to repair a large defect of the right nose after MOHS surgery . An interpolated forehead flap was performed in two stages.
MOHS Reconstruction Overview

Goals To repair a defect created from injury to the face. The most common cause of this is from the removal of facial cancers, especially after MOHS micrographic surgery.

The Procedure There are several different types of flaps or grafts that may be used for repair. The type of repair necessary is determined once defect is examined.

Anesthesia Most reconstructions are performed under local anesthesia in the office. Larger repairs may be performed under twilight sedation in an ambulatory surgical center. Rarely is general anesthesia required.

Length of Time Depending on the size of the defect, repair can average approximately 30 minutes to 2 hours.

Before and after photos of a skin graft to the nose
Skin graft for repair of a MOHS surgery defect on the bridge of her nose

After the Procedure The vast majority of patients go home immediately after the procedure. When performed in the outpatient surgery center under twilight anesthesia, you will be observed for approximately one hour after the procedure prior to being discharged with a companion.

Recovery Most patients can go back to work the day after the procedure. Some people opt to take more time off depending on the type of repair performed. You will be given specific wound care instruction prior to leaving the office in order to allow for the best possible healing and outcome.

Facial Reconstruction FAQs
Why would I need facial reconstruction?

Skin cancer is the most common form of cancer in the United States. It is highly prevalent in people who have had significant exposure to sun throughout their childhood and into adulthood. The climate and weather in South Florida makes it a hot bed for this type of cancer.

Before and after photos of a flap performed to repair a MOHS surgery defect of the cheek
A cheek rotation flap performed to close this defect from MOHS surgery

Fortunately, the majority of skin cancers are treatable with removal. Often times a surgeon or dermatologist will treat a skin cancer by excising it. MOHS surgery is a popular method for removing skin cancer. The advantage of MOHS surgery over standard excision, is that the edges of the removed cancer are carefully examined under the microscope at the same time as when you are having the cancer removed. This allows the MOHS surgeon to be certain that the entire cancer was removed without leaving any of the "roots" behind. Success with MOHS surgery has been reported to be 99%. The benefit of MOHS surgery in an areas such as the face or nose, is that the amount of healthy tissue removed is kept to a minimum without comprimising the removal of the cancer.

Who performs MOHS micrographic surgery?

MOHS surgery is performed by a qualified dermatologist with specialized training in the MOHS procedure.

How is skin cancer reconstruction performed?

MOHS reconstruction is performed utilizing different types of grafts and/or flaps to close the defect. The type of repair performed depends on the size and location of the wound.

Before and after photos of a MOHS surgery repair of the cheek.
Bialteral advancement flap performed after MOHS surgery
What is a graft?

A graft decribes the process by which tissue from one area of the body is used to repair or replace tissue in another area of the body. An example of this is a skin graft. Skin grafts are autologous grafts, meaning they are taken from your own body. Skin grafts are useful to repair certain types of skin cancer or traumatic defects. Other examples of grafts are cartilage grafts. Cartilage grafts can be taken from the ear, nasal septum, or the rib. They are often used to repair large defects of the nose and/or ear.

What is a flap?

A local flap describes a repair tha involves using the surrounding skin and soft tissue in order to close a defect. This is analogous to putting a puzzle together. There are many different types of flaps that can be performed to repair skin cancer defects. These include transposition flaps, interpoolated flaps, island flaps, and advancement flaps.

Paramedian forehead flap with ear cartilage graft was performed to repair the MOHS defect on the nose
Interpolated forehead flap with ear cartilage graft to repair a large nose defect from MOHS surgery.
When will you decide what repair is best for me?

You will have a good idea about which type of repair may be necessary prior to the removal of the skin cancer. The final decision will be made once the entire cancer has been removed and the defect is examined.

Can I see examples of the type of reconstruction that I may need?

Yes. We will show you an extensive photographic library of patients who Dr. Steiger has repaired to give you a better idea of what to expect. Some very large defects may require staged procedures. If this may be necessary we will show you exactly what you can expect after the procedure.

Where will my procedure be performed

Many reconstructions are performed in our comfortable office procedure room. Larger repairs are performed in an outpatient ambulatory surgical center.

Before and after photos of a cheek island advancement flap to an upper lip MOHS surgery defect
Island advancement flap closure of upper lip MOHS defect
Does insurance cover MOHS reconstruction?

Yes. Most insurance companies will cover reconstruction after MOHS micrographic surgery.

Will I have much pain after the procedure?

No. Most patients do not complain of significant pain after the procedure. In fact, the majority only take over the counter Tyelnol for pain. We will prescribe you a mild narctic pain medication just in case you may need it after surgery.

When can I return back to work?

Most patients prefer to take several days off after the procedure. However, you may return back to work as soon as the next day. If a larger flap is performed, you may want to take more time off of work depending on your profession. You should discuss this with your doctor depending on your type of work and the procedure performed.



 





Dr. Jacob D Steiger MD is board certified by the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology- Head & Neck Surgery. He practices in Boca Raton and Delray Beach, Florida treating patients from Palm Beach, Ft. Lauderdale, Miami, as well as patients from all over the US and from around the world.



Call 561-499-9339 or 866-994-FACE to schedule an appointment today, or email info@drsteiger.com for more information