Facial Reconstructive Plastic Surgery

What is skin cancer excision surgery?

Skin cancer excision surgery is either performed using the Mohs technique or by
removal of the lesion with a ‘margin’ of normal tissue. Moh’s surgery is most commonly
performed in vital areas around the eyes, lips, or nose, where you would want to keep
as much healthy tissue as possible.

When is Mohs surgery indicated?

Many of skin cancer types can be treated with the Mohs procedure. The most
commonly treated skin cancers are squamous cell carcinoma and basal cell carcinoma.

What is reconstructive surgery?

Reconstructive surgery is the process of repairing the defect left behind, after the
removal of the skin cancer. This can be achieved by advancing the edges of the defect
together or by moving nearby tissue into the defect. Reconstructive surgery is usually
performed in the office under local anesthesia. Larger reconstructive procedures may
need to be performed in the hospital under anesthesia.

Who performs reconstructive surgery?

Mohs surgery is performed by physicians with advanced training in the procedure.
Some Mohs surgeons will perform the closures following removal of the skin cancer,
especially if it is only a small defect. Alternatively, a Plastic Surgeon will perform the
reconstruction of the defect This is especially true if the resultant loss of tissue is
significant and presents technical and aesthetic challenges. If the defect is not correctly
reconstructed, permanent distortion with an abnormal appearance, may result.

What if I want a plastic surgeon to perform my reconstruction?

You should speak with your Moh’s surgeon or dermatologist and discuss using a plastic
surgeon for the reconstruction. This is important if the cancer is in a critical region,
particularly on the face. The closure can be performed on the same day or a separate
day. The dermatologist may remove the skin cancer and apply a clean dressing and you
can then be seen by the plastic surgeon for the reconstructive stage. It is important to
know the options available to you for both the skin cancer removal as well as the
repair.

Does the surgeon I chose to make a difference?

The Plastic Surgeon you chose makes a difference. There is only one kind of Plastic
Surgeon certified by the American Board of Plastic Surgery. There is only one Board of
Plastic Surgery recognized by the American Board of Medical Specialties which in turn
oversees the certification of Board and Residency Training programs. The terms ‘Facial
Plastic Surgeon’ and ‘General Plastic Surgeon’ are used by Ear Nose and Throat
(ENT)Surgeons who call themselves Facia Plastic Surgeons. These terms are used to
suggest to the patient that Plastic Surgeons are not qualified to work in the Facial area.

Given that most face-lift surgeons are Plastic Surgeons, this is an argument that is
difficult to follow. ENT surgeons will often call themselves ‘Plastic Surgeons’ and will not
make it clear that they are not certified by the American Board of Plastic Surgery.
Plastic Surgery Residency training is a rigorous residency program. It cannot be learned
in weekend course or a Fellowship. The residency is specifically dedicated to the
Practice and Art of Plastic Surgery. The American Board of Facial Plastic Surgery is not
a recognized Board by the American Board of Medical Specialties.

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