Learning you have skin cancer on your face or neck is frightening. Most skin cancers are able to be removed surgically. However, you may be worried about the effects of the process and the subsequent facial reconstruction.
“There is a limited amount of skin on the face, and particularly on the nose, that can be used to repair the area where cancer has been removed,” said Dr. Nathan Schreiber. Schreiber is a Marshfield Clinic facial plastic and reconstructive surgeon, head and neck surgeon and otolaryngologist (ear, nose and throat specialist).
“The other thing to consider is function,” he said. “Removing tissue can distort how we breathe, open and close the mouth and eyelids, and communicate with people.”
Certain reconstructive techniques can minimize the appearance of scars and maintain or restore nasal breathing and movement in your face.
“It’s important to hide incisions in areas where there are natural shadows or lines to camouflage scarring,” Schreiber said.
Facial reconstruction can be a single- or multi-stage process
Patients who have large areas of skin cancer removed may be referred by their dermatologist for reconstruction at a later time. In some cases, cancer removal and reconstruction are performed at the same time.
Other times, reconstruction is performed in multiple stages. Closing larger or more challenging areas may span a few weeks or even months. This is most common when reconstructing large parts of the nose, where skin from the forehead or cheek is sometimes used.
“There’s no way to make the area look exactly like it did in the past, but we try to make it as close as possible,” Schreiber said. “Sometimes additional surgical stages can be used to contour a reconstruction for a better match with surrounding skin.”
The patient’s goal is important in deciding how to perform surgery. Some patients want incisions to blend in as much as possible, while others want minimal surgery. Certain health conditions, tobacco use and previous face or neck radiation treatment make surgery riskier and can limit reconstruction options.
Reconstruction can help correct old scars
There is hope if you have an old scar that hasn’t healed to your satisfaction.
Scars from traumatic injuries tend to be more obvious because there can be surrounding tissue damage. An old scar from a surgery that didn’t heal well or was oriented in an unfavorable direction may be too noticeable.
Scar revision can change the position of a scar, remove puckering and provide better scar camouflage in some cases.
Take care of healing scars
Facial reconstruction often is meant to reduce the impact of a scar, but it does cause some scarring itself. Taking care of these scars will help the skin look as natural as possible once it heals.
“One of the most important things you can do to decrease the prominence of a scar is keep it moisturized in the weeks and months after surgery,” Schreiber said. “Sun exposure also makes scars more pigmented compared to the surrounding skin, so sun protection is very important, especially in the year after surgery.”
Full recovery generally takes anywhere from a week to several months, depending on the extent of surgery.