Face Reconstruction After Mohs Surgery, Injury or Trauma
Facial trauma requires sensitivity and an extremely skilled team of doctors, including a facial plastic surgeon. Defects in the face can be the result of an injury or burn. Facial defects may also be from the final stage of Mohs micrographic surgery.
After you get appropriate medical treatment and have been stabilized or been found tumor-free, you can then move on to the next phase of the process which is skin reconstruction.
During this reconstruction phase, surgeons can vary significantly in their approach and results. Dr. Simoni is a skin reconstruction expert, with extensive experience in defects of the nose, ears, lips and facial skin. He uses highly advanced reconstruction techniques to create the most natural cosmetic results possible. Dr. Simoni also focuses on minimizing visible scarring.
Methods of Addressing Facial Defects
- There are typically five options for the repair or healing of facial defects:
- Allow the wound to heal by itself.
- Repair the defect in a straight line.
- Use a flap closure, which involves the mobilization and stretching of nearby tissue.
- Use a graft closure, which consists of the transfer of skin from another site such as behind the ear.
- Use a combination of 1 through 4
Dr. Simoni is unique in that he primarily uses unique flap reconstructions in order to deliver the best cosmetic outcomes. This is especially effective since the skin used in the flap repair matches the texture, color and thickness of the missing skin.
A skin graft from another location will never exactly match these characteristics. It can take 3 to 12 weeks of daily wound care to allow the wound to heal on its own. This also increases the chances of unpredictable scarring. Results may be excellent, but they also may cosmetically unacceptable.
For these reasons, Dr. Simoni recommends flap reconstruction. With this technique, Dr. Simoni can remove sutures after one week and achieve a predictable result and scar. A linear closure may be chosen depending on the location of the defect, but Z-shaped or L-shaped flap repairs offer a much better cosmetic result. Linear repairs that cross facial creases are much more visible and may stretch and spread as time passes.
Important Information on Facial Suturing
Another key aspect of advanced facial reconstructive surgery is ensuring the suturing of the skin is meticulous. Dr. Simoni is expert at the use of subcutaneous or buried sutures in his closures. Buried sutures dissolve over one to three months and give the skin edges time to create a strong bond that will help avoid delayed spreading of the scar, which is common in wounds closed with only superficial or top sutures. Dr. Simoni ensures buried sutures are placed properly so that they will completed close the wound edges and allow superficial sutures to be used effectively to align skin edges. Buried stitches fully address wound tension that would otherwise leave the “railroad track” scars that are typical with inferior stitching methods. Skin edges that are aligned well on day one will result in a scar that is barely visible as time passes.
It is normal for scars to heal over a 12-month period, but Dr. Simoni’s suturing technique can create scars that will resolve remarkably in six weeks or less.