Facial Reconstruction after MOHS Surgery
Mohs micrographic surgery (MMS) is a surgical technique in which minute layers of skin tissue are meticulously removed and examined under a microscope.
By removing thin layers of tissue in this incremental manner, the physician can be sure that all involved tissue is excised, and can simultaneously spare healthy tissue. Of all the surgical techniques available today, Mohs surgery offers both the lowest recurrence rate of malignant lesions, and maximum preservation of healthy tissue. Mohs surgery is performed by specialized Dermatological Surgeons who only perform skin cancer removal, and then refer patients for reconstruction to a Dr. Monica Tadros, M.D., F.A.C.S facial plastic surgeon.
Reconstruction of the face and the vital structures contained within the head and neck after tumor resection is both extremely challenging and rewarding. The type of neoplasm and location typically dictate the optimal method for removal. Resection by open, endoscopic or MOHS techniques results in a variety of defects that make each clinical scenario unique. Reconstruction of the defect requires extensive experience and expertise to restore optimal form and function to critical areas of the face, head and neck.
MOHS Surgery & Facial Reconstruction In Depth
Mohs surgery is a highly specialized treatment for the total removal of skin cancer. This method differs from all other methods of treating skin cancer by the use of complete microscopic examination of all the tissues removed surgically as well as detailed mapping techniques to allow the surgeon to remove the entire lesion.
Its utility is greatest in the face where tumor resection can be disfiguring. Tissue is serially removed attempting to clear margins of tumor while conserving as much normal tissue beyond the limits of tumor. Real time microscopic evaluation of these serial sections helps guide the surgeon and ensure that margins are cleared.
MOHS Reconstruction refers to the utilization of any number of local flaps and grafts to reconstruct the face after an open defect is created by MOHS surgery. The emphasis is placed on evaluation of the depth of the defect, considering skin, fat and muscle loss. Most often the extent of tumor resection is at or near critical structures, including the eyelid, lips and facial nerves. Occasionally these critical structures are sacrificed due to tumor involvement and must be incorporated into the plan for restoration. The procedure is performed without hospitalization under a local anesthetic. The visible lesion and a very thin layer of skin are removed with a scalpel, carefully mapped, and examined microscopically.
If there is still cancer seen under the microscope, another very thin layer of skin is removed from that exact location. This is repeated as often as necessary to completely remove the cancer. Mohs surgery removes as little normal tissue as possible, minimizing scarring.
Repairs range from very simple excision and closures of small defects, to complex local tissue rearrangements, and even microvascular free tissue transfer.
Our goals are to:
- Maximize the chance of cure.
- Minimize the effects of the treatment on one’s appearance.
The fact that our surgeons specialize in cosmetic facial surgery as a substantial component of their practice leads to high patient satisfaction with the final results.
Who is a Good Candidate?
Patients who have larger skin cancers, recurrent skin cancers, or cancers on their face, including sensitive areas such as the nose, lips, ears, and eyelids, may be candidates for coordinated care between the Mohs dermatologists and a plastic surgeon. Typically, the tumor will be removed by the best Mohs surgeons in NJ one day, and reconstruction of the defect will be performed the following day by the plastic surgeon.
Mohs surgery is an advanced dermatologic surgery technique to remove skin cancer performed by dermatologic surgeons. Dr. Tadros uses a wide variety of techniques in her Plastic Surgery Clinic in NJ & NYC to optimize wound healing and final cosmetic result. He typically creates exceptional cosmetic results with all of these reconstructions.
Why is Form & Function Important In Facial Tumor Reconstruction?
Dr. Tadros has been working with dermatologic surgeons and head and neck surgeons to reconstruct even the most complex defects after tumor resection. The complexity of aesthetic restoration goes beyond scar optimization to preserve or restore facial function, sensation and nerve function. Facial restoration of post-surgical defects requires experience and artistry. Experience with a wide range of surgical techniques makes the best aesthetic and functional outcome possible. Artistry guides the decision-making process on how to optimize scars and grafts to restore contour and optimize scars into natural facial shadows.
Planning for microsurgical reconstruction requires a detailed evaluation that includes setting expectations. There are cosmetic changes that may occur, as well as some losses of function.
We assess each patient for potential donor sites from which tissue can be borrowed with the least functional losses and maximum gain. Occasionally special imaging studies are obtained to look for available blood vessels to be used in the free tissue transplant. On the average the expected hospital stay ranges from 3 to 7 days.
Dr. Monica Tadros, M.D., F.A.C.S. is a distinguished Sinus, Sleep and Facial Plastic Surgeon and Fellow of the American College of Surgeons. She is one of a small number of surgeons to attain double board certification by the American Board of Otolaryngology and the American Board of Facial Plastic & Reconstructive Surgery.