Skin Cancer Reconstruction

Mohs micrographic surgery (MMS) is an advanced state-of the-art skin cancer treatment designed to remove cancerous skin cells from patients while leaving all healthy tissue intact. Mohs surgery is performed by specially trained dermatologic surgeons who exclusively perform skin cancer removal. These patients are then referred to facial plastic surgeons for reconstruction. Double board-certified plastic surgeons Dr. David Lieberman and Dr. Sachin Parikh, as well as board-certified facial plastic surgeon Dr. Steven Curti, perform skin cancer reconstruction at our Palo Alto office, with consultations available at our Los Gatos, CA, location, as well.

Mohs surgery is extremely effective for all skin cancers, and is especially valuable for recurrent or aggressive carcinomas. Because it conserves the maximum amount of healthy tissue, Mohs is ideal 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). Mohs surgery is now frequently used to remove basal cell carcinomas, squamous cell carcinomas and other skin lesions on the face.

Reconstructive Surgery
 Before & After Photos

Case: 1 of 9
Case: 1 of 9
Middle aged Bay Area woman receives reconstructive surgery for open area.
Enclosed area reconstructed without signs of surgery.
Case: 1 of 8

Case #217

This necessary procedure was done by Drs. Lieberman and Parikh. You cannot even tell that she underwent surgery as she has not scarring and no signs of skin cancer. 
Reconstructive surgery done with no signs of surgery
Closure enclosed in a cosmetic way
Case: 2 of 8

Reconstructive surgery done on the edge of the nose

Reconstructive surgery is just as much of an art than rhinoplasties or facelifts because it still requires careful suture technique. As you can see this patient shows no signs of surgery or an open region in her face. 
Reconstructive surgery for previous skin cancer patient
Skin cancer removal left patient with the need of cosmetic reconstruction.
Case: 3 of 8

Reconstruction done to cover previous skin cancer area.

Drs. Lieberman and Parikh do work on several skin cancer patients to enclose their exposed area in a way that would not be noticeable in any close encounter. 
Upper Lip Reconstruction
No signs of surgery with L&P reconstruction surgery
Case: 4 of 8

Upper Lip Reconstruction

This beautiful patient shows zero signs of surgery and looks amazing. Reconstruction surgery is a very fulfilling procedure. 
Amazing reconstructive surgery by Drs. Lieberman and Parikh
Zero signs of any reconstructive surgery in final result
Case: 5 of 8

Zero signs of reconstructive surgery in final result

Fabulous before and after of reconstructive surgery. This photo maps out the process of healing and lays out the final results with minimal scarring. 
Seamless reconstruction done for beautiful Bay Area woman
Reconstruction before and after for middle aged woman
Case: 6 of 8

Before and After Reconstructive surgery

This woman shows no sign of needed or receiving reconstructive surgery. Drs. Lieberman and Parikh use advance surgical techniques to minimize scarring and reduce signs of any type of procedure. 
Reconstruction procedure done for middle aged woman
No signs of surgery for middle aged woman undergoing reconstructive procedure.
Case: 7 of 8

Reconstructive surgery on top of the head

Reconstruction surgery done at the top of the head makes the procedure a little more difficult because of the hair in the surrounding area. This procedure had a great result leaving no scars. 
Reconstruction surgery to enclose area right above the ear.
Surgically enclosed area that will heal with zero scars.
Case: 8 of 8

Reconstruction surgery above the ear.

Reconstructive surgeries are performed by Drs. Lieberman and Parikh on all areas of the face. There are several techniques that can be used to address all of the concerns with reconstructive surgery. 

Keep in mind that each patient is unique and your results may vary.

During the surgery to remove the skin cancer, small layers of skin cancer tissue are meticulously removed. The Mohs surgeon examines the tissue under a microscope for cancerous cells. Mohs surgeons remove thin layers of skin in an incremental manner so all cancerous tissue is excised, and the maximum amount of healthy tissue is spared. Mohs surgery offers both the lowest recurrence rate of malignant lesions, and maximum preservation of normal, healthy tissue.

After a malignant lesion is removed with Mohs surgery, a depression or hole in the skin is present. Such scars may be rather disfiguring, and reconstructive surgery may be performed immediately after Mohs surgery to repair the damaged site. We specialize in carefully reconstructing the facial tissue in such patients, restoring their natural appearance while preserving form and function of important structures of the face. We work closely with a number of Mohs surgeons in the area to offer a highly specialized service. Our goal is to create a seamless transition from skin cancer removal to unparalleled reconstruction so that patients are cared for at each step of this process.

Pre-Operative Process

Am I a candidate for skin cancer reconstruction?

Skin cancer occurs most commonly on the face, and frequently develops on the nose. Many times the Mohs surgeon removing the skin lesion will be able to reconstruct the area at the time of the initial procedure. Depending on the size, the complexity, and the location of the resection, your Mohs surgeon may elect to have a facial plastic surgery reconstructive specialist assist in your treatment.

Even skin lesions that appear very small initially, can involve large areas of normal looking skin. Many Mohs surgeons can anticipate the need for a reconstructive specialist prior to removal of the skin cancer, especially if the skin cancer is in cosmetically sensitive areas such as the lip, eyelid, nose or ears. In that case, you will have a formal consultation with us before your Mohs surgery to discuss all reconstructive options. For most patients, after your Mohs surgery is completed, the Mohs surgeon will bandage the wound and direct you to our offices for a consultation. We strive to offer same day service. At your post-procedure consultation, the defect is assessed, and all options for reconstruction will be discussed in detail.

Dr. Parikh, Dr. Lieberman, and Dr. Curti

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How is this surgery performed?

Most defects can be repaired with skin flaps. A skin flap utilizes local redundant tissue to cover the Mohs defect. Sometimes, a skin graft will be utilized for reconstruction. A skin graft involves removing a piece of skin from a donor site (e.g. back of the ear or above the clavicle) and then sewing it into the Mohs defect.

Sometimes more of a complex or multiple staged reconstruction is required. This depends on the amount of tissue that is removed and whether other tissue such as cartilage and bone must be reconstructed and replaced. We specialize in these more complex surgeries. Whether you have a flap or a graft, evaluation for possible further refinement is performed at approximately the sixth post-operative week.

How long is the procedure?

Mohs reconstructive surgery can be performed under local anesthesia or mild sedation and takes anywhere from 30 minutes to two hours depending on the complexity of the surgery. We are experienced in Mohs reconstructive surgery under local anesthesia, thus patients frequently can avoid a trip to the hospital operating room or surgery center. Patients go home the same day and return typically three to five days after surgery for suture removal.

Our core objective is to provide a safe, comfortable surgical experience that aspires to restore your appearance and aims to produce natural results. Always feel free to call the clinic at (650) 327-3232 or make an appointment online to meet with one of our surgeons in Palo Alto or Los Gatos. We focus exclusively on cosmetic and reconstructive enhancement of the face and neck and are uniquely qualified to handle your case.

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