Healing by secondary intention means the wound left after Mohs micrographic surgery is not stitched closed. It is dressed and allowed to fill in and close on its own, from the base upwards and the edges inwards. In the right position it can give a better cosmetic result than any repair.
It is a deliberate surgical decision, not a lesser option. Miss Rakhee Nayar, who is dual-trained in Mohs and plastic surgery, will recommend it where the natural contour of the area will do a better job than a flap or graft.
When a wound is left to heal naturally
- Concave areas that naturally cup inwards: the inner corner of the eye, the side of the nose where it meets the cheek, the bowl of the ear and the temple.
- Shallow wounds where the surrounding skin is thin and closing it would distort a nearby feature.
- Patients for whom a longer operation is not advisable.
- Situations where it is preferable to watch the area heal openly before considering any further surgery.
How long it takes
Most wounds take between three and eight weeks to close fully, depending on size, depth and site. Smaller wounds on the face are usually at the faster end of that range. The wound gets smaller each week rather than all at once.
- Week 1. The wound produces some fluid and forms a soft yellow layer at the base. This is healthy granulation tissue, not infection.
- Weeks 2 to 4. The wound visibly contracts inwards. New pink skin creeps in from the edges.
- Weeks 4 to 8. The surface closes over. The new skin is pink and delicate.
- Months 3 to 12. Colour and texture settle and the scar pales.
Looking after the wound
You will be shown how to clean the wound and change the dressing, usually daily at first. The key principle is to keep the wound moist and covered rather than letting it dry into a hard scab, because moist wounds heal faster and scar less. You will be given written instructions and a point of contact if anything concerns you.
What the scar looks like
In the concave sites listed above, a secondary intention scar often blends remarkably well, sitting flat and pale within the natural shadow of the area. On flat or convex surfaces it is more likely to be visible, which is why the site matters so much to the decision. If the final result is not what you hoped, scar revision remains possible later.
Book a consultation
To discuss Mohs surgery and reconstruction with Miss Nayar, please use the contact form or call the clinic directly.