Mohs surgery and reconstruction: What timeline to expect?

Hello I had squamous cancer on my bottom lip, which was cut out back in 2007. I lost pretty much my whole lower lip and a portion below my lip too. They did a graf and flap to help with movement and actually they put too much tissue in the place where they removed my lip and it's real puffy. Almost looks like I'm chewing tobacco. Embarrassing and deformed since then. I was always told there wasn't anything they could do because they now refer to it as being cosmetic. I guess that means I would have to pay out of pocket to try to look more normal.. such a terrible thing to be told. I live my life indoors or looking down all the time. Not how anyone should be. Recently someone asked how come insurance will pay for a woman to have breast implants after she had hers removed due to cancer. I was shocked. I feel our faces is the first thing that everyone sees so I would think our faces would be covered..

@keithl56 I like the way your surgeon prioritized your procedure. Some of them have a way of seeing that things get taken care of when needed. He also sounds like he is on top of your other issues to make this procedure as safe as possible for you. My aunt did not take blood thinners, but any bleeding was quickly contained by ample cautery. Not a pleasant odor, but very effective at controlling bleeding. Her 3 cm circular lesion is filling in with granulation tissue 3 weeks postop with another month or more to completely heal. No graft done and she will have a hairless area that size on top of her head. Better than cancer. I have been forced to learn that appearance isn't everything after surgery resulting in facial paralysis and synkinesis where facial muscle control is permanently changed. It can be hard to accept, but over time you learn to laugh and live with it. Maybe you will learn a good makeup technique to help? And Halloween offers so many opportunities! I carved a right sided facial paralysis pumpkin the first year!

Thanks for the response. Unfortunately, the area that would be grafted is on my scalp/forehead area so cosmetically there will be no way to avoid disfigurement. The surgeon already warned that it will not be the same color or texture as the surrounding area. I guess I can be Frankenstein this Halloween!

Unfortunately, all of my doctors are in Delaware. Healthcare in Hilton Head isn't great with Savannah or Charleston the place to go if you need specialized care. If I move down full time I'll have to establish a new healthcare network. It looks like I'll be heading north more frequently and spending more time there as necessary. I'm trying to group my appointments so that I can knockoff multiple doctors each time.

Update. I saw the Moh's surgeon last week and the reconstruction surgeon this week. While waiting for the surgeon on Monday I asked how far out they were scheduling surgeries (I am planning on heading to my Hilton Head house from Mid Aug to mid Nov) and she told me to figure on Aug-Sept (bummer). However, when the doctor came in and drew a roadmap on my head he said that the cancer could double in size in a few months and was checking my lymph nodes. He left and then the nurse took me to the scheduler. I was surprised when she said that she was trying to get my surgery scheduled for next week but couldn't get me in until 6/26.

Also surprising was he was talking about possibly having to do a skin graft and showed me on my side what he would use as a donor site, and that it wouldn't match the area around it.. He also told me not to discontinue blood thinners since he can handle the bleeding and didn't want to risk a heart attack or stroke, and also didn't want to use general anesthesia for the same reason. Kind of freaked me out. So it looks like local plus valium.

Anyone have any similar experience that can provide any input?

TIA Keith

@keithl56 Not exactly sure where the surgery site will be, but I myself wouldn't worry if the skin graft doesn't match surrounding area.

Because I am on a chemotherapy medication that carries increased chance of stroke, I am told to not take off any doses of my baby aspirin each day, for minor procedures. All of my skin cancer surgeries have been done with a local anesthetic.

It sounds like your surgeon is proactive to get the procedure done as soon as possible, and that's a good thing! Do you have access to a dermatologist while at your house on Hilton Head, if needed?
Ginger

Update. I saw the Moh's surgeon last week and the reconstruction surgeon this week. While waiting for the surgeon on Monday I asked how far out they were scheduling surgeries (I am planning on heading to my Hilton Head house from Mid Aug to mid Nov) and she told me to figure on Aug-Sept (bummer). However, when the doctor came in and drew a roadmap on my head he said that the cancer could double in size in a few months and was checking my lymph nodes. He left and then the nurse took me to the scheduler. I was surprised when she said that she was trying to get my surgery scheduled for next week but couldn't get me in until 6/26.

Also surprising was he was talking about possibly having to do a skin graft and showed me on my side what he would use as a donor site, and that it wouldn't match the area around it.. He also told me not to discontinue blood thinners since he can handle the bleeding and didn't want to risk a heart attack or stroke, and also didn't want to use general anesthesia for the same reason. Kind of freaked me out. So it looks like local plus valium.

Anyone have any similar experience that can provide any input?

TIA Keith

Hello @keithl56 . I just had my elderly aunt to the surgeon for her Mohs procedure on her scalp on top of her head. It was quite superficial in the biopsy and we waited 3 months for an appointment for the surgery. It was removed in the first pass and instruction is to allow for granulation to heal this over the next 6-8 weeks. It is kept covered with antibiotic ointment and gauze and has been quite painless for her. With a 3 cm round area now open, there was no way to bring scalp edges together. At age 97, reconstructive surgery was not mentioned.
The scalp is a very vascular area so significant cautery was used to control bleeding. Granulation tissue is very vascular also so I am not concerned about blood supply for healing. Good luck to you.

Hello I had squamous cancer on my bottom lip, which was cut out back in 2007. I lost pretty much my whole lower lip and a portion below my lip too. They did a graf and flap to help with movement and actually they put too much tissue in the place where they removed my lip and it's real puffy. Almost looks like I'm chewing tobacco. Embarrassing and deformed since then. I was always told there wasn't anything they could do because they now refer to it as being cosmetic. I guess that means I would have to pay out of pocket to try to look more normal.. such a terrible thing to be told. I live my life indoors or looking down all the time. Not how anyone should be. Recently someone asked how come insurance will pay for a woman to have breast implants after she had hers removed due to cancer. I was shocked. I feel our faces is the first thing that everyone sees so I would think our faces would be covered..

Hello I had squamous cancer on my bottom lip, which was cut out back in 2007. I lost pretty much my whole lower lip and a portion below my lip too. They did a graf and flap to help with movement and actually they put too much tissue in the place where they removed my lip and it's real puffy. Almost looks like I'm chewing tobacco. Embarrassing and deformed since then. I was always told there wasn't anything they could do because they now refer to it as being cosmetic. I guess that means I would have to pay out of pocket to try to look more normal.. such a terrible thing to be told. I live my life indoors or looking down all the time. Not how anyone should be. Recently someone asked how come insurance will pay for a woman to have breast implants after she had hers removed due to cancer. I was shocked. I feel our faces is the first thing that everyone sees so I would think our faces would be covered..

I just put in a long post about my scc's. the one on my hairline was a huge opening with long cuts so that it could be closed to heal smoothly. It always suprises me how relatively painless the recovery is compared to how it looks. My dermo MOHS surgeon at Mayo did an excellent job even though it required 6 passes to get it all. Took 3 months to close up enough for 20 radiation treatments. It was red for a few weeks and now almost a year later, not noticeable. My hairline is actually straighter than it was although my forehead a big higher. I'm pleased and thrilled at what was done.