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07.03.2015
After Mohs surgery, there is a missing area of skin on the face or neck that is called a “defect”.
Goals To repair the defect created after Mohs surgery and recreate a normal appearance to the face with minimal appearance of a scar while preserving function and avoiding distorting any surrounding facial features.
The Procedure There are several different types of flaps or grafts that may be used for repair.
A skin graft is graft of skin taken from another area of the body and placed as a free graft over the defect site. A local flap move the tissue surrounding a defect into the defect utilizing the skin laxity of the surrounding area. Dr Funk will discuss the different option for reconstruction with you during your initial visit. This patient had a large defect of his lower eyelid and cheek which required a large advancement flap to close. Patient with upper lip skin cancer (top), after Mohs surgery (middle), and after lip reconstruction (bottom). Patient with upper lip cancer (left), after Mohs surgery (center), after lip reconstruction (right). His practice offers Expert Treatment of Lip Defects along with other Skin Cancers Located on the Head, Neck and Face including the Nose, Ears, Cheeks, Eyelids and the Scalp.
Additionally, our practice offers diagnosis, treatment and recontruction of suspected or confirmed skin cancers on the face, neck and scalp.
Doctor Jacono is part of Face to Face (Click here to learn more) and is one of a small group of Facial Plastic and Reconstructive Surgery Specialists who volunteer their time to perform Reconstructive Surgery on women who are victims of domestic violence pro-bono. The photographs that follow are graphic, but help demonstrate how reconstructive surgery can help restore normal facial appearance and function. Mohs micrographic surgery (MMS) is a surgical technique in which minute layers of skin tissue are meticulously removed and examined under a microscope.
After a malignant lesion is removed with Mohs surgery, a depression or hole in the skin remains. Mohs Reconstructive Surgery Patient 2: Nasal Defect Reconstruction with Multiple Staged Repair. After your Mohs surgery is complete your dermatologist will bandage the wound and send you to Doctor Jacono's office. Sometimes more complex or multiple staged reconstruction are required depending upon how much tissue is removed and whether other tissue such as cartilage and bone must be reconstructed and replaced. Whether you have a flap or a graft, evaluation for possible further refinement with dermabrasion is performed at approximately the sixth post-operative week. Mohs Reconstructive Surgery Patient 10: Nasal Defect Reconstruction with Multiple Staged Repair.
Mohs Reconstructive Surgery Patient 12: Nasal Defect Reconstruction with Multiple Staged Repair. Mohs Reconstructive Surgery Patient 17: Nasal Defect Reconstruction with Multiple Staged Repair. Mohs Reconstructive Surgery Patient 26: Nasal Defect Reconstruction with Multiple Staged Repair. Doctor Andrew Jacono is pleased to introduce J PAK SYSTEMS™ - two homeopathic remedies for use before and after aesthetic injectable and surgical procedures to help minimize swelling and building. Additionally, our practice offers diagnosis, treatment and reconstruction of suspected or confirmed skin cancers on the face, neck and scalp.


Many thanks for all your incredible skill, hard work and a level of care I think would be unmatched anywhere. His practice offers Expert Treatment of Lip Defects along with other Skin Cancers located on the Head, Neck and Face including the Nose, Ears, Cheeks, Eyelids and the Scalp.
Our affinity for the sun and outdoor activity expose us to many of the harmful UV rays that cause skin cancer. This defect can be reconstructed by your Mohs surgeon, or if more complex, by Dr Etai Funk, a facial plastic surgeon. He or she may feel that you will obtain a better result with a facial plastic surgeon whose efforts are concentrated solely on repairing your defect and not removing the cancer.  Fortunately, the majority of skin cancers are treatable with removal.
Skin grafts are important for color and texture match and therefore the donor site needs to be chosen appropriately. There are many different types of flaps that can be performed to repair skin cancer defects. However, the final decision will not be made until after the Mohs surgery when the defect has been made.
James Pearson is a Board-Certified Facial Plastic & Reconstructive Surgeon - whose practice serves the greater Los Angeles Area with offices in Beverly Hills and the South Bay. Pearson’s practice offers lip reconstruction for skin cancers affecting the lip as well reconstruction and non-surgical treatments for lip injuries due to trauma, birth defects, scars, piercings or prior surgery. Pearson’s practice offers lip reconstruction for skin cancers affecting the lip as well reconstruction and non-surgical treatments for lip injuries due to trauma, birth defects, scars, piercings or prior surgery. Andrew Jacono is a Dual Board Certified, Facial Plastic and Reconstructive Surgeon located in Manhattan and Long Island.
By removing thin layers of tissue in this incremental manner, the physician can be sure that all involved tissue is excised, and can simultaneously spare healthy tissue. However, its precision is especially valuable for recurrent or aggressive carcinomas, for treatment of cosmetically important areas such as the nose, eyelids and lips, and for high risk and invasive lesions (such as near a facial nerve). Such scars may be rather disfiguring, and reconstructive surgery may be performed immediately after Mohs surgery to repair the damaged site. Patient underwent a neck transposition flap, and forehead and cheek rotation flap to close this large defect. This defect required a two staged surgery using a pedicled (stays attached to the donor site) cheek flap and ear cartilage graft to reconstruct the natural curvature of the nasal rim.
This defect required a two staged surgery using a pedicled (stays attached to the donor site)paramedian forehead flap. A nasal crescenteric lip advancement flap was utilized to reconstruct this defect of the lip.
A specialized flap called a tenzel flap was used to reconstruct the eyelid, and the lacrimal (tear duct) apparatus was reconstructed. A nasal cresenteric lip advancement flap was utilized to reconstruct this full thickness defect of the lip. A chondrocutaneous V to Y advancement flap with a full thickness skin graft was used to restore natural contour to this ear. Pearson’s practice offers Lip Reconstruction for skin cancers affecting the lip as well reconstruction and non-surgical treatments for lip injuries due to trauma, birth defects, scars, piercings or prior surgery. He takes time with me each and every visit to address all of my concerns and never makes me feel rushed. Basal cell cancer and squamous cell cancer are two common types of skin cancer that are removed using Mohs surgery.


There are many factors that need to be considered when repairing a defect after Mohs surgery. You will be given specific wound care instruction prior to leaving the office in order to allow for the best possible healing and outcome. Skin grafts require a bolster or dressing that holds the graft in place while it establishes a blood supply. These include transposition flaps, interpoolated flaps, island flaps, and advancement flaps.
If a larger flap is performed, you may want to take more time off of work depending on your profession. Of all the surgical techniques available today, Mohs surgery offers both the lowest recurrence rate of malignant lesions, and maximum preservation of healthy tissue. Mohs surgery is now frequently used to remove basal cell carcinomas, squamous cell carcinomas, and other lesions on the face. Unlike the rest of the body, the face is a focal point of attention that is not easily hidden from view.
The location, size, orientation, and depth of the defect are essential in formulating a reconstructive plan.
After the bolster is removed, skin grafts may at first appear depressed or discolored, but will soon become less conspicuous over time.
You should discuss this with your doctor depending on your type of work and the procedure performed. Jacono specializes in carefully reconstructing the facial tissue in such patients, restoring their skin's natural appearance. Unlike most doctors, his patient care extends beyond the office with a routine, friendly follow up call or email.
For this reason, many patients choose to have their surgical defects, created from skin cancer removal, repaired by a facial plastic surgeon.
The advantage of MOHS surgery over standard excision, is that the edges of the removed cancer are carefully examined under the microscope at the same time as when you are having the cancer removed. My previous doctor performed several surgeries and was not encouraging about what I would look like after the repair.
He works closely with highly qualified MOHS surgeons in order to coordinate the best possible care for his patients. This allows the MOHS surgeon to be certain that the entire cancer was removed without leaving any of the "roots" behind.
The benefit of MOHS surgery in an areas such as the face or nose, is that the amount of healthy tissue removed is kept to a minimum without comprimising the removal of the cancer.
Reconstruction involving the face and facial structures is particularly delicate given the visibility of this area and its impact on one’s appearance and social interaction. Reconstruction involving the face and facial structures is particularly delicate given the visibility of this area and its impact on one’s appearance and social interaction.
He educated me on my situation, was realistic but encouraging about the results, and thoroughly explained my options.



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