Reconstruction planned to keep scarring to a minimum and help you recover well.
Women in the UK dual-trained in Mohs and plastic surgery
Natural-Looking Recovery
Reconstruction After Mohs Surgery
The primary goal of any skin cancer treatment is the complete removal of the tumour. However, for many patients, especially those with Basal Cell Carcinoma (BCC) on the face, nose, or ears, the concern doesn’t end with a “cancer-free” diagnosis. The question often becomes: “What will I look like afterward?”
This is where Mohs Reconstruction with a specialised plastic surgeon like Miss Rakhee Nayar becomes essential.
Miss Nayar is trained in both Mohs surgery and plastic surgery, so she plans the removal and the reconstruction together, and performs both.
Understanding the Process
What is Mohs Surgery?
Before the reconstruction begins, the cancer is removed and the margins are checked under the microscope. Mohs Micrographic Surgery is used for common skin cancers such as Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC), especially when they occur in cosmetically sensitive areas like the face, nose, or ears.
Reconstruction techniques offered
Surgical Expertise
Why Specialised Reconstruction is Essential
When it comes to the face, “closing a wound” is not the same as “restoring a feature.” While a standard surgical closure involves pulling two edges of skin together with stitches, the face often needs more than that.
The Complexity of Facial Anatomy
The face has delicate contours, openings that have to keep working, and skin that varies in thickness. In areas where the skin is tight, such as the bridge of the nose, the rim of the ear, or the margins of the eyelids, there is very little “give.”
If a large Mohs defect in these areas is simply stitched together, it creates tension. This tension can lead to:
- Ectropion: A pulling down of the lower eyelid, causing dryness and irritation.
- Nasal Distortion: A "notched" or pinched nostril that affects both breathing and symmetry.
- Oral Incompetence: A pulling of the lip that can affect speech, eating, and your natural smile.
The Plastic Surgeon's Touch
Miss Rakhee Nayar views reconstruction through the lens of “Facial Subunits.” This means she doesn’t just look at the hole; she looks at how that hole sits within the natural boundaries of your face.
By utilising her specialised training, she ensures:
- Hidden Scars: Incisions are placed within natural "relaxed skin tension lines" where possible or the shadows of the face (like the crease of the nose or the hairline) so they disappear as they heal.
- Preserved Function: Keeping the nose, mouth or ear working as it should in the long term.
- Symmetry: Using "like-for-like" tissue from nearby areas so the colour, texture and hair growth match the surrounding skin as closely as possible.
Treatment Pathways
Reconstructive Surgery Options for Mohs Patients
Once the Mohs surgeon has confirmed that the margins are clear of cancer, the “defect” (the remaining wound) must be repaired. Miss Rakhee Nayar employs a tiered approach to reconstruction, selecting the technique that best preserves the natural movement and function of your facial features.
Direct Closure
For smaller or shallower defects, a direct closure is often the most straightforward solution.
The Technique: Miss Nayar carefully brings the edges of the wound together & secures them with layered, ultra-fine sutures.
The Result: This creates a thin, linear scar. By aligning the closure where possible with your “Relaxed Skin Tension Lines” (the natural wrinkles or creases of the face), the final scar often becomes nearly invisible once fully healed.
Local Flaps
When a wound is too large to be pulled together without distorting nearby features (like the eye, nose, or lip), a local flap is the preferred method.
The Technique: This involves moving healthy skin from an immediately adjacent area to cover the defect. The skin stays attached to its original blood supply (the “pedicle”) as it is moved.
The Result: Because the donor skin comes from just millimetres away, it provides an exact match for skin colour, thickness, and texture.
This works well for facial reconstruction, as it allows Miss Nayar to “re-drape” the skin to follow the natural contours of your face.
Skin Grafts
In cases where there isn’t enough loose skin nearby to create a flap, a skin graft may be required.
The Technique: A piece of healthy skin is completely removed from a “donor site”, typically from behind or in front of the ear, neck, collarbone, or the inner arm, and stitched carefully into the Mohs defect.
The Result: While grafts may have a slightly different texture or colour than the surrounding facial skin, Miss Nayar’s expertise in “thinning” and placing the graft ensures it integrates as smoothly as possible. This is often used for larger areas on the nose or ears.
Request an e-Consultation
Miss Nayar offers a convenient e-Consultation service for patients seeking a specialist opinion from across the UK and overseas. This secure digital pathway enables remote assessment of skin lesions and concerns, providing a prompt clinical recommendation.
It is an ideal first step for those considering Mohs surgery or reconstruction before travelling for an in-person appointment.
Begin Your Healing
What to Expect
Knowing what to expect on the day of your procedure can make it less worrying. Miss Rakhee Nayar’s aim is to keep the day as calm and simple as possible, with the repair following straight on from the cancer removal.
When Does the Reconstruction Happen?
One of the most common questions is whether the repair happens immediately after the tumor is cleared.
Same-Day Reconstruction: In the vast majority of cases, Mohs reconstruction is performed on the same day as your Mohs surgery. Once Miss Nayar confirms that the margins are clear, you will move to the reconstructive phase immediately.
The 24–48 Hour Window: Occasionally, if the Mohs surgery takes several stages and concludes late in the day, or for specific complex repairs, Miss Nayar may schedule the Mohs reconstruction for the following morning. This is rare. The wound is safely dressed in the interim, and this short delay does not negatively impact the final result.
How Long Does the Procedure Take?
The reconstruction is the part of the day that takes the most care.
Precision Takes Time: Depending on the complexity of the repair (whether it is a simple direct closure or a more involved local flap), the surgery typically takes between 1 and 2 hours. Skin grafts can be performed within an hour usually.
Efficiency: Because Miss Nayar is highly experienced in facial anatomy, she works efficiently, without keeping you in theatre longer than necessary.
A Painless Experience
We look after your physical and emotional comfort during your Mohs reconstruction.
- Most procedures are performed under local anesthesia. This involves numbing only the specific area being treated. You will be awake but will not feel any pain during the process.
- Once the local anesthetic wears off, most patients report only mild discomfort, which is easily managed with standard over-the-counter pain relief.
Precision surgery. Natural results.
Why Choose Miss Rakhee Nayar?
Choosing the right surgeon for your Mohs reconstruction is a decision that impacts both your health and your confidence. Miss Rakhee Nayar combines surgical training in two specialties with a research background and a careful, patient-centred approach.
Trained in plastic surgery and Mohs surgery
In the UK, surgical specialties have historically been male-dominated. Recent data from the Royal College of Surgeons shows that female representation is growing. With women now making up approximately 17% of all surgical consultants, Miss Nayar belongs to an even more exclusive group.
She is one of fewer than 10 women specialists in the UK who are dual-trained as both a Consultant Plastic Surgeon and a Mohs Surgeon. This unique overlap in expertise means she doesn’t just “close” a wound; she reconstructs it with the detailed knowledge of a plastic surgeon and the pathological understanding of a skin cancer specialist.
Clinical Background & Professional Affiliations
Miss Nayar’s work is grounded in extensive training and a commitment to surgical safety and ethics.
Safe Recovery Support
Recovery & Aftercare
Following Mohs reconstruction, the first 48 hours focus on elevation and protection to manage swelling. Miss Nayar typically removes sutures within five to seven days, during which time you should avoid strenuous activity to prevent tension on the repair.
Long-term results depend on proactive scar management once the wound closes. This includes daily SPF and gentle massage to soften the tissue.
While initial redness fades quickly, the scar will continue to mature and blend naturally for up to a full year or eighteen months in some cases.
In Patients' Words
Patients Feedback
What Our Patients Say
Schedule Your Private Consultation
Book a personal consultation. Meet with Miss Nayar to discuss your concerns, ask questions, and receive a bespoke treatment plan focused on your care.
or Call Us Now
07740 306144
Circle cheshire Clinic
The Courtyard, Hall Ln, Wincham, Northwich CW9 6DG, United Kingdom
07740 306144
contact@mohssurgeon.co.uk
Schedule Your Visit
Where to See Miss Nayar
Miss Rakhee Nayar provides specialist Mohs and reconstructive surgery at Circle Health Cheshire Clinic. This modern, private facility offers expert care in a discreet environment for patients across Cheshire and the North West.
07740 306144
Frequently Asked Questions
We're Always Here to Help You
What reconstruction method will I need?
The specific technique depends on the size and location of the wound left after the cancer is cleared. Miss Nayar will evaluate the defect on the day of surgery to decide between a direct closure, a local flap, or a skin graft, choosing the option that best fits your facial structure.
Will reconstruction leave a scar?
All surgical procedures result in some scarring, but Miss Nayar’s expertise lies in “hiding” these lines where possible. By placing incisions within natural skin creases or expression lines, she aims to make the scar less conspicuous. Over time, with proper aftercare, these lines typically fade into the natural contours of the face.
Can reconstruction be done on the same day as Mohs surgery?
Yes, in most cases, your Mohs reconstruction is coordinated to take place immediately after Miss Nayar confirms the margins are clear. If the removal process concludes very late in the day, the repair may be scheduled for the following morning rather than performed at the end of a long list.
Where can I see Miss Rakhee Nayar?
Miss Nayar consults at several prestigious locations across the North West. You can book a private consultation at her clinics in Northwich, Rainford, St Helens to discuss your specific needs.
Will I be awake for the surgery?
Most patients remain awake but comfortable under local anesthesia, which completely numbs the surgical sit.
Is the surgery painful?
The procedure itself is painless due to the local anesthetic. You may feel some minor pressure or a “tugging” sensation, but no sharp pain. Afterward, any mild discomfort is usually easily managed with standard paracetamol or ibuprofen.
Should I take my usual medications before the surgery?
You should continue most medications, but tell Miss Nayar about any blood thinners (such as aspirin or warfarin) or supplements you take. She will provide specific instructions during your pre-operative consultation on whether to temporarily pause these.
Should you massage a scar after Mohs surgery?
Yes, but only once the wound is fully healed and the sutures are removed, usually around three weeks after surgery. Regular, gentle massage with a simple moisturiser helps break down internal scar tissue, keeping the area soft and helping the scar flatten more quickly.