Skin Cancer Reconstruction
The treatment of skin cancer on cosmetically sensitive areas, such as the face, presents a difficult problem. Over time, techniques such as MOHS micrographic surgery have been developed that provide effective treatment of the cancer while also minimizing the amount of tissue that needs to be removed. However, once the cancer has been removed, there is often a wound that must be closed with utmost attention towards preserving the aesthetic appearance.
In order to reconstruct the wounds caused by MOHS surgery and skin cancer treatment, Dr. Liu will use a variety of techniques including direct closure, tissue rearrangement, skin grafts, local flaps, and even eyelid sharing procedures in some instances. On the face, there are multiple local flaps that Dr. Liu can use to maximize the aesthetic appearance in cosmetically sensitive areas such as the nose, lips, and eyelids. Dr. Liu individualizes the treatment to each wound, location, and situation, and she will work with your dermatologist, surgical oncologist, or skin cancer treating physician to provide you with the best aesthetic and oncologic result possible.
Selecting the right surgeon for skin cancer reconstruction is very important. When performing surgery in one of the most delicate skin areas of your entire body that also has one of the most intricate anatomy, the pool of surgeons qualified to perform such a procedure shrinks dramatically.
When dealing with any problem near the eye, you need to see a physician trained as an ophthalmologist. Many doctors are not comfortable working in that area because of the specialized anatomy and will refer you to an ophthalmologist anyway. Additionally, because this is an extraocular procedure (outside of the eye) as opposed to an intraocular procedure (inside of the eye), the best choice is an oculoplastic surgeon (also known as an ophthalmic plastic and reconstructive surgeon).
A well-trained oculoplastic surgeon can combine their knowledge of the eye with the artistic expertise of a plastic surgeon. You need a doctor that can ensure that the procedure is done correctly, but also won’t leave an unsightly scar. Dr. Liu is an oculoplastic surgeon and has completed an ASOPRS fellowship, making her one of the most highly qualified oculoplastic surgeons in North America.
Skin cancer reconstruction is typically performed using local anesthesia in Dr. Liu’s procedure room or under sedation at an off-site surgery center, but only in very rare cases would general anesthesia be used.
There are several techniques that Dr. Liu uses for skin cancer reconstruction, depending on the size, depth, and placement of the defect. Because Dr. Liu has such specialized training, she has access to a number of techniques that are not utilized by most other doctors, and she may mix and match these techniques to get the best outcome. The specific techniques that Dr. Liu uses will be selected based on your needs.
Dr. Liu can perform a reconstruction using direct closure, tissue rearrangement, flaps, grafts, or a combination of these. If a lid-sharing procedure needs to be performed, your eye may need to be closed for one month after surgery. The function and appearance of the reconstruction are both important considerations in the final outcome.
Skin cancer reconstruction typically takes about 1 to 2 hours from start to finish.
Skin cancer reconstruction may have some scarring at the area of the incisions, however, Dr. Liu will try to minimize scarring as much as possible by following the natural skin lines. Non-specialized surgeons typically have results with more visible scarring.
Skin cancer reconstruction is generally a very safe procedure. When considering any eyelid surgery, it is important to inform your surgeon of any abnormalities of your eyes, vision, or your general medical health. Dr. Liu requires all eyelid surgery patients to have a full eye exam with dilation completed within the last year before scheduling surgery.
It is important to remember that while all surgery carries some risks, even when performed by the most highly trained surgeon and at the best facilities. Below are some of the more common risks associated with surgery:
The likelihood of serious complications arising from the procedure is typically influenced by both the surgeon’s skill as well as the patient’s individual response to the eyelid surgery. Certain severe risks or complications can be avoided by cooperating fully and completely following your surgeon’s instructions. With patience, a willingness to cooperate, and a qualified surgeon, the complications of eyelid surgery and any associated risks can be dramatically reduced.
Surgery should be scheduled for a time when you can relax for at least 1-2 weeks. It is important to avoid any strenuous activity, heavy lifting, or bending down during this time to avoid complications and to promote the best healing. It is also important to avoid taking any blood thinning medications for at least two weeks prior to surgery. If you are on a blood thinning medication due to a specific medical condition, you will need to discuss this with Dr. Liu and your primary care physician prior to stopping any medication. Dr. Liu’s staff will review a list of common medications, supplements and vitamins that can cause your blood to be thinner.
In general, recovery after MOHS or skin cancer reconstruction depends on the surgery that Dr. Liu performs. Simple closures or skin grafts cause little pain or discomfort. Larger flaps and more extensive procedures have longer recovery times. At the time of your surgery, Dr. Liu will discuss your expected recovery time with you.
Please note that Dr. Liu expects to see patients back in the office a few days after a procedure to ensure that the healing process is going as expected and that you are on track for a good result. Do not plan any travel immediately after your procedure.