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What is Mohs surgery? Will I need facial reconstruction?

Mohs surgery is a precision technique to remove skin cancers. Thin layers of skin tissue are removed, one after the other, examined under a microscope, with the process continuing until the skin is cancer-free. Mohs surgery is typically performed with MAC anesthesia (Monitored Anesthesia Care) Twilight Sedation, where the patients are breathing on their own. . After the area treated has fully healed, facial reconstruction surgery is performed to fill in divots or sunken areas of the face to restore a more natural appearance. 

At Rousso Adams Facial Plastic Surgery, we do not deliver Mohs Surgery, but we expertly deliver post-Mohs reconstruction to repair the subsequent defect. Dr. Rousso and Dr. Adams specialize in reconstructing the soft tissue defects created by these procedures on the face, ears, nose, and scalp. Reconstructive surgery can help individuals put their cancer experience behind them and serve as a final stage of healing.

Approximately 15 percent of patients who undergo Mohs surgery will need reconstructive surgery. When the initial procedure leaves a visible facial defect, reconstructive surgery is necessary. Skin grafting and flap techniques to restore a smoother, less obvious look to the surgical site.

Skin grafting for facial reconstruction

Skin grafting involves harvesting healthy skin from another body area and transplanting it to the facial area. If you have suffered skin cancer and had Mohs surgery, cosmetic surgery can improve the function and appearance of the area with a skin graft. 

There are two types of skin grafts: a full-thickness skin graft and a partial-thickness skin graft. Full-thickness grafts remove both the epidermis and the dermis; partial-thickness grafts remove the epidermis and only some of the dermis.

Full-thickness grafts are smaller and are generally used for less extensive damage on the facial skin and tissue. The donor site is repaired by pulling together the area from which the healthy skin is harvested and closing it with surgical staples or sutures. Unlike partial-thickness grafts, full-thickness grafts blend with adjacent skin and often have a superior cosmetic result. 

Flap facial reconstruction

Flap surgery involves removing a larger quantity of tissue from a donor area. Flap surgery involves transplanting the tissue, along with the blood vessels to repair a larger area of damage. This advanced surgery requires exceptional skill, both in choosing tissue that will best blend with the surrounding skin and transplanting to create the most natural, smooth look.

Nasal reconstruction after Mohs

For nasal reconstruction after Mohs, you may require a staged procedure, with a tissue expander placed on the forehead. Once the body has produced enough skin, it will be harvested and transplanted to restore a more natural look to the nose.

What can Mohs surgery and facial reconstruction treat?

Mohs surgery removes all cancerous skin cells, followed by custom facial reconstruction appropriate for the size and shape of the removed cancerous cells. These procedures can treat the following:

  • Nose reconstruction
  • Ear reconstruction
  • Lip reconstruction
  • Eyelid reconstruction
  • Facial trauma treatment
  • Facial scar treatment

Candidates for Mohs surgery and facial reconstruction

Any skin cancer affecting the face can be treated with a combination of Mohs surgery and custom facial reconstruction. The procedures may take place in a single surgical appointment or reconstruction later. The first step is to meet with us so we can evaluate your condition. We often work in liaison with other medical professionals in treating skin cancers and performing facial reconstruction.

How are Mohs surgery and facial reconstruction performed?

The procedure involves removing thin sections of cancerous skin, after which the tissue is examined under a microscope, with the surgery continued until all cancer cells present are removed. It is followed by facial reconstruction, customized to match the size and shape of the wound created in Mohs surgery. The technique used to reconstruct the area may require skin grafts, tissue grafts (flap surgery), or other procedure, based on need. Mohs surgery is performed with local anesthesia. Reconstruction may be performed with local or MAC Anesthesia (Monitored Anesthesia Care) Twilight Sedation, or local anesthesia with intravenous sedation.

Recovery after Mohs surgery and facial reconstruction

It may require four to six weeks to fully heal after Mohs surgery or Mohs surgery with facial reconstruction. Full recovery may require longer when skin grafts or flap surgery is performed. The recovery time varies, based on the type of reconstructive surgery performed, along with scar revision techniques to create the most natural look, but typically several months will be required, with follow-up appointments during healing to monitor the success of treatment, and plan any further reconstructive actions.

Mohs surgery and facial reconstruction at a glance

  • Procedure time: Varies, based on the size of cancer, several hours required
  • Anesthesia: Local anesthesia, and for reconstruction, or MAC Anesthesia (Monitored Anesthesia Care) Twilight Sedation, or intravenous sedation with local anesthesia
  • Typical recovery time: Four to eight weeks
  • Can it be performed with another surgery? Scar revision, skin resurfacing, dermabrasion, steroid injections, laser treatments, or other skin repair treatments

Why Choose Rousso Adams Facial Plastic Surgery?

As a world-renowned plastic surgeon specializing in the face and neck, Dr. Rousso has more than 30 years of experience and has gained worldwide recognition for his contributions to the field of plastic surgery and is among the finest facial reconstruction specialists in the state. Dr. Adams is double board-certified in facial plastic surgery and otolaryngology-head and neck surgery, making him an expert in facial anatomy. 

Our facility uses state-of-the-art medical equipment and many of our staff have been with Dr. Rousso for more than 20 years. If you need Mohs surgery and facial reconstruction, you will be under the care of some of arguably the best facial plastic surgeons in the region.

We offer a patient experience above and beyond what you will find elsewhere, including concierge services on par with the best five-star hotels. Our friendly staff can help you arrange travel and hotel accommodations, lab appointments, sitters, aftercare and many other services from start to finish. If you are considering reconstruction surgery in Birmingham, Montgomery, or surrounding areas, contact us today.


Can I achieve a natural look after skin cancer treatment with Mohs surgery that led to extensive skin and tissue removal?

The skills of your facial plastic surgeon are critical. Our facial plastic surgeons understand your wish to achieve an appearance that is not distracting, unusual, or odd in appearance, and will use the most advanced techniques to help you look and feel your best after treatment.

How long will it take to recover from Mohs surgery and facial reconstruction?

You may need between six and eight weeks to recover, with added scar treatments once the area is healed.

Can the nose, lips, or eyes be restored to appear natural after Mohs surgery?

Custom facial reconstruction techniques employed at Rousso Adams Facial Plastic Surgery can restore a very natural appearance when significant quantities of the cancerous tissue were removed in Mohs surgery.

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