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Ron Shelton M.D.

#317 East 34th Street,
11th Floor, New York, NY 10016. 

I had Mohs surgery on my nose two months ago and had a flap done to close the hole. I am happy but the flap appears slightly lumpy. What can be done to improve this?

It may take several months, without assistance, for the lumpiness to improve. Sometimes massage helps but you would have to discuss this with your surgeon. Some flaps develop a swelling that make it “round up” and this may need multiple treatments with corticosteroid injections and even a secondary surgical procedure to thin out the flap. The thinning might not be done at time of initial surgery as this could interfere with the blood flow and compromise the integrity of the flap. Resurfacing can be done for the incisional groove around the flap if necessary using Fraxel laser or dermabrasion, usually not done immediately but after 6 to eight weeks, sometimes earlier. The cosmetic secondary procedures are rarely, if ever, covered by insurance carriers so discuss this with your doctor.

 I had Mohs surgery on my scalp a few months ago and everything was fine until recently when I started to lose my hair in the area of the scar. Will I be permanently bald because of the surgery?

What you’re describing is a normal telogen effluvium. This is a temporary hair loss related to a shift in the growth cycles of the hair shafts. Usually all hair grows in one of three phases, a resting, a growing and an intermediate phase. The stress of the surgery can make all the hairs go in to a resting phase. When the new phases reenter, the new growing phase pushes the resting phase hair shafts up and out. The irony is that when you see the hair falling out that actually is the sign that the hair is starting to regrow.

It could be however, that you are describing a lack of sufficient blood flow, or a scar that has started to spread apart thereby creating a patch of permanent hair loss. Hair transplants can be done in such a scar.

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