Well, it’s done.
The dermatologist did the Mohs procedure on Thursday morning. It took 3 passes to get all the cancer out, and I was left with a defect about the size of a dime on the lower left part of my nose. Sort of like this –
Despite what was being done to me, I had a good time at my Moh’s surgeon’s office. We talked kids, and schools and family and money – and then I hung around his little back Mohs waiting room for a few hours till my plastics appointment, returning patient calls and checking labs on my laptop (one of the curses and advantages of an EMR). I left feeling relieved and upbeat.
Until I saw the plastic surgeon.
The Closure
Where my dermatologist is an upbeat, everything is going to be fine kind of guy, Dr Plastics is an empathetic, caring, almost rabbinical kind of guy who really understands how women feel about their faces. So when he entered the room and saw the size of my defect, he looked at me with those dog-eyes of his, looking so sorry for me that I started to cry. He told me the defect was larger than he had expected, and that he would not close it in the office, but under anesthesia at the surgi-center the next morning.
I walked home crushed, sure that I was going to be deformed for the rest of my life. And the fact that I had to spend the night with this hole in my face did not help. What if something happened and I couldn’t get to the surgery tomorrow? Suppose there was a fire, or I got hit by a car, or one of my kids got sick? I’d have to decide between them and closing the hole in my face.
Somehow I got through the night, and next morning went to the surgi-center. What a place – an Upper East Side townhouse that, when you enter, looks for all intents and purposes like a private mansion. Until you head into the back, where the place looks just like any recovery room and OR suite you’ve ever been to. Runs like a well-oiled machine, wonderfully friendly staff and anesthesia, high quality care. A real New York kind of place.
I waited for several hours in a gown on a gurney, listening mostly to my neighbors letting go of gas after colonoscopies while I finished almost all of the Friday NY Times crossword, a feat worth mentioning in any post. My nurse had had two surgeries similar to mine in the past, a fact I did not notice until she pointed out the faint scars. This made me feel hopeful.
Then my surgeon appeared, apologizing profusely for keeping me waiting due to his previous case that had gone longer than expected. I felt oddly reassured by this, figuring that he would take as long as he needed to give me the best cosmetic result he could.
So to sleep I went, the Fentanyl and Versed doing their job quite nicely, and awoke some 30 minutes later, finally done. Dr Plastics had performed a bi-lobed flap and used about 20 tiny stitches to close. So I have an incision running from near my inner eye down the side of my nose that looks like a half of a flower. Sort of like this –
Nice, Huh?
Post-Op
In addition to the incision, I have a black eye and my nose is swollen and red. The pain isn’t too bad during the day, but has kept me up a bit at night, and my stomach is a bit upset from the antibiotics.
Now I just have to wait. Wait for the sutures to come out next week. Wait for the swelling to go down and the scar to fade. It will be sometime before I know how I am going to look, but at least this thing is done.
I find myself embarrassed thinking about having to see patients over the next few weeks with a big bandage on my nose. I wish I had taken off a little more time from work, but everyone said I could go back pretty much right away, so I’m going back on Tuesday. But I feel like it’s all going to be about the nose for sometime. And I am anxious for the point when I can cover the incision with some makeup until the scar starts to fade.
Most people I talk to are remarkably supportive and no one seems particularly worried about how I’m going to look. But somehow their comments haven’t helped. They only make me feel as if I am over-reacting.
And in some respects, I am. I think about Patrick Swayze and know that I am so, so lucky that this is all I have to deal with. And truth be told, I haven’t thought about my nose too, too much today, as we are now on the 7th episode of the first season on The Wire.
But then, I look at myself in the mirror, and get upset all over again. It makes no sense, I know, but this thing has really hit me hard. I think it was the combo of the big hole, the unexpected wait and and then the Frankenstein sutures, and I expect I’ll feel much better about things in a week or so. But right now I’m feeling pretty darned sorry for myself.
After all, it is my Nose.
_________________________________________________
If you want to see photos, go here. I’ll be posting updates periodically as I heal. I warn you, it’s not pretty……
Thank you for the very intimate post, and best of luck with your recovery.
GruntDoc
Your eyes look a little sad, but the stitches and all look very tiny. I hope you heal up in no time!
ps. Congrats on finishing the crossword!
I know, it’s ridiculous, you doctor, me patient, but having spent almost 3 months in a surgical unit, I promise you it will be fine.
The ‘Plastics Guys’ are all great, and caring with a capital C!
If he says it’ll be OK, then that’s what it will be.
Come on, chin up, as my late mother-in-law used to bizarrely say, ‘It’ll be a pig’s foot in the morning’.
Okay, your biggest comfort should be the fact that you got Mom’s cute Irish nose and not Dad’s big Hungarian nose (as this sibling of yours was so blessed with…). Your scar will fade with time – I will still look like Grandmom when I am 60:)
XOXO, OBS Housekeeper
Did you think that this was going to be one of those soft, emotional, Lifetime movie moments? From me? Schruggling?
Here are my suggestions:
1. Bone up on your acting skills and start going to self-help groups, proclaiming that you have finally hit bottom…the black eye will be a HUGE hit. Try to cry on the spot. Also, target groups that may have agents in them…you never know.
2. Tell people that the other half of the clover will be in place for St. Patrick’s day. You are in NYC afterall, and who doesn’t want a clover? (too bad that it will be gone and undetectable by then.)
3. Start your own plastic surgery reality show – Dr. 10019. Rather than you doing the procedures on others, you can show the procedures being done on you!
Heal well. You will not be able to notice anything in no time at all…so get that reality series while you can!
Umm, Schruggling’s #3 reminds me of the performance artist Orlan. Doesn’t strike me as quite your style…
Bardiac,
So true. I am off on this one for sure. However, the need to tap into TV is overwhelming. Perhaps a signature series on the Tyra Banks show? That could work too.
“She’s normally a doctor in NYC, but now, she’s a patient. Here to tell her woes of the Mohs on her nose is Dr. TBTAM…” After TBTAMs intro, she sits with Tyra and describes the ordeal. Tyra cries with her since only Tyra would understand the critical need for nose preservation. Then, in her moment of cartharsis, TBTAM takes the stage and sings “I Feel Pretty” to show young women all over America that they can be pretty with skin cancer too…and alas, Tyra again will enhance humanity with her presence.
After viewing your pic, this was going to be a reassuring “you look like someone who had surgery and who will heal very nicely” comment but I have been horribly distracted by the remarks of Bardiac and Schruggling and am working to get the earworm “I feel pretty” out of my head…
In all seriousness, in a few weeks you’re going to be wondering what your concerns were all about. I think the surgeon did a great job 🙂
A
schruggling – Would that be ‘America’s, next, top, doctor’ by any chance?
I think it will be beautiful in a few weeks. You must be so glad that you got a plastics doc to do it right?
Good luck. The time will go by fast. Your patients will still love you.
I didn’t notice any black eye.
Your eyes do look sad.
Always Plastics for anything facial!
Heed Ramona’s advice!
Thanks for sharing, and here’s to invisible scars.
If you extend the lines to meet, it will be heart-shaped and you know that just means love. So think of all the people you love and who love you and it will take your mind off this soon to disappear scar.
Grunt Doc – Thanks so much.
Bardiac – You’re right. They were a little sad. But happier today after all these kind words 🙂
OBS – But I LOVE grandma’s nose!
Schruggling – Love all the ideas. I’m going to put you in touch with my agent. On second thought, do YOU want to be my agent? (I sing a mean version of I feel Pretty, complete with accent)
Bardiac – Oh my god, that Orlan woman is nuts!
Artemis- Actually, went back today for post op, and Dr Plastics was really pleased with how it’s looking. He rearranged my bandage 3 different ways while we were talking to find just the right way so I could only have to use one bandage instead of the 3 I have been using. I love this guy…
Thanks for the kind words.
Chairwoman – Funny 🙂 (Hope you’re doing well…)
Pe Mommy – Thansk so much.
MMT – The bruising under the eye had gotten more yellow by the time I took the photo. It’s faded even more today. The doc told me today that he will likely be injecting stuff as the scar forms to keep the flap part from getting too thick and red.
Irene – That comment brought more than a few tears to these eyes. Thanks for the love, and much, much more back at you in return….
He did a beautiful job. Really, really beautiful! I know it looks huge and scary right now, but I can tell you’re going to have a wonderful result. Please, please take photos as it heals in and post them for other Mohs patients.
The wicked part of me is hoping you’ll have a few snappy replies handy for those, er, nosy people who stare or ask.
“Bar fight.”
“Slashed with a broken beer bottle.”
“My husband has a terrible temper.”
(Maybe not the last one.)
BTW, I couldn’t help but notice that you have beautiful skin, which I am currently obsessed about these days. Any secrets you could share? Please don’t tell me it is just good genes. I need hope.
I’m sorry to hear about your nose Mohs. But it does sound like your plastic surgeon knows what he is doing. Good to get it taken care of and all.
Anyway, I’ll be thinking good thoughts for you.
Oh, and congratulations for finishing the NYT crossword!
TBTAM, take care. Love all the comments above, esp Annapolitan’s. Made me smile.
I am glad it all went well. Thank you for sharing this most informative post.
I think I should see a dermatologist for a head to toe and have some things to look at.
I admit that even though I know better, I have been afraid to pursue it. It seems like people I know have to keep on going back and the whole idea of something being excised out, scarring and pain just unnerves me. Yet…catching something when it is small is what one would want to do.
I tried to look at pics but blogger wouldn’t cooperate but will try again.
I hope you heal quickly and uneventfully.
Oh and you are as human as the next person and it is perfectly alright to be concerned about your appearance. Yes…Patrick is going through something more serious and it could’ve been worse for you. But even if you have just a hangnail…that little hangnail still hurts you. Your nose and appearance is certainly more important than a hangnail. OK…maybe that wasn’t the best analogy…but pain is still pain…even if it is emotional…it still hurts.
Who knows? Maybe your posting about this or personal contacts you make that discuss this with you will have their lives saved because of what you say. I never heard of MOHS and now you’ve got me thinking maybe I really should go in for the dermatology head to toe.
Wishing you a speedy recovery. 🙂
I hope you’re feeling better.
Late to the party, but FWIW I think your plastic surgeon did a beautiful job! I hope you are feeling well and that your shiner is fading.
I have to go to the derm every six months (fam history of melanoma, many, many nevi) I think I could keep my Dermatologist in business with harvesting my various atypical nevi, alone.
Have a great weekend!
I can’t tell you how happy I am that I came across your Blog while feverishly trying to research all things Mohs & Nose. What a friendly oasis in what otherwise is a clinical, cold and quite terrifying world of dermatological information. Thank you for your personal saga filled with great information, warmth and humor! (I love the drawing of your nose character and the red dot at the top of the ) I have a baso-squamous carcinoma on the very tip of my very prominent and very pointy schnoz. (It’s actually located on the left hand corner of the tip.) I have Mohs surgery and plastic surgery scheduled for tomorrow in New York City where I live. I’m freaking out — crying, taking Ativan and fighting with my husband. I just turned 46. I had a completely unrelated surgery two months ago on my shoulder — arthroscopic. I’ve been going to physical therapy for my shoulder and feeling sorry for myself. Intense arthritis in my joint. Blah, blah, blah. And now, THIS! I feel like I just stepped dead center into middle-age. A spotlight should shine down on me for all the world to see. BUSTED. No more pussy footing around on the edges of youth. You’re 46. Get busy with the ailments of the body! I know that I should be grateful that nothing is fatal. But like you said — it’s my NOSE! Which in my case arrives at my destinations before I do. My emissary. My friend that helps me breathe and smell things. And then there is the small matter of my FACE… And I’m a woman who takes pride in how she looks. I’m not a girly girl. I’m just a proud-type person. All this to say, I am terrified of disfigurement. I met with the very esteemed plastic surgeon that will be doing the honors hoping that he would say something to relieve my terror prior to the surgery. He was wildly empathic, but didn’t soft-sell the difficulties in keeping the nose in tact. Apparently, the tip is quite problematic and tough to preserve. He laid out a bunch of scenarios. Everything depends on the size of the excision. Of course, I’m praying that it’s small and self contained — but it’s a crap shoot. Anyway, thank you for telling your story of Mohs woes. You’ve made another New Yorker feel much less alone the night before her big day of Mohs and the long unsightly recovery ahead.
To Anonymous up there,
Good luck with your surgery.
Think of yourself as a beautiful tapestry of imperfection.
Amonymous –
Do tell us how it goes. I’ll bet it’ll be fine.
TBTAM
Thank you so much for your blog. I’ve just completed the same procedure–3 rounds of Mohs, closure the next day–and have gone through every feeling you described. I get my stitches out in a couple of days, and your pictures have made me feel so much better about the eventual outcome of all this. Your nose looks great! Congratulations on being on the other side of all this, and again, thank you for sharing.
Thanks for sharing so much. I had two Mohs procedures (one on nose, one on lip) done on 5/14. Both required closure by a plastic surgeon, which was done on 5/16 (weird waiting two days with two gaping holes). The nasal defect, weighing in at 2.4 cm or so, was big enough to warrant a paramedian flap, which I named Pedro the Pedicle. The lip defect was “only” 1.2 cm and was closed by removing a section of the lip. While I try to maintain a humorous exterior for others, it’s physically uncomfortable.
Thanks for this blog and for sharing your thoughts and your pictures. IMO, you are healing very nicely. Your post was comforting since I recently had a lesion open suddenly on the side of my nose, a year after a basal was found on my arm. I went to the surgeon downtown who had treated my arm. The arm surgery–my first skin cancer experience–but I fear not my last–was an eye opener for me. The doc told me he was going to biopsy the arm, but he didn’t tell me he was going to cut out a chunk of skin 2 inches long for a spot the size of a freckle. Later he called to tell me it was cancer but that he got it all. So when I went for the nose, and he would not talk to me at all before cutting to describe what the outcome might be, or how much he was going to cut (he says, no time for talk, I am a surgeon–I cut–do you want the surgery or not?), I freaked out and walked out. I found a dermatologist uptown who did a very small biopsy, and diagnosed precancer. The biopsy has left a dimple in the side of my nose. Yesterday I had the skin frozen and now the dimple is larger, the size of a pencil eraser. The nurses there told me that I was so lucky its not cancer and that I dont need mohs, but frankly, I think your nose looks better than mine. After your scars heal, your nose will look more whole. I also fear that despite the freezing the spot will come back and be cancer. I wonder, can you recommend a mohs doctor and plastic surgeron?
I am so glad I came across your post about MOHS surgery. I have just been diagnosed with Basel Cell just a little over from my right nostril. I am very nervous about it and worried about pain. But your post made me feel better. I have a question tho.. when the derm was looking at it before the biopsy, she noticed a small kind of flat spot on the right side of my nose.. you can barely see it.. she said at first.. I think this is another one.. well maybe not.. then dropped it.. do you thinkn I should insist on a biopsy for that spot.. its not shiny and white like the basal cell one, I am really paranoid now. I think I will ask for a plastic surgeon as well. thank you!!!!!
Jennifer –
I had a similar situation recently with a new spot on the other side of my nose – we decided to take it off anyway, and it was indeed dysplastic and so we then froze the spot. I was glad we decided to go ahead anyway.
Not saying it what you should do, just telling you what I did.
Best,
TBTAM
I had nose Mohs surgery this week March 25, 2009. I have a lot swelling on the lower cheeck. Can you tell me how long it will take for swelling to go down. I had a negative report after the first incision, and then he did a flap along the side of my nose about 1 1/2 in. long.
I had Mohs Surgery done in April on my nose. I had about 17 or 18 stitches. Now the area is itchy like crazy. Did this happen to you? what did you do?
Jeanne -I hope you udnerstand that I can't give out personal advice on this blog. I will say that it is not uncommon for healing scars to itch. But I would ask your doc before applying or doing anything to the scar.
Thanks for reading!
Jeanne
Yes, I did have itching, and still have some (almost 3 mos now) and I have to apply cocoa butter with Vitamin E and massage the scar for 10 min. a day, every day until I go back to Dr. in October. My Dr. said the itchy nose is from the nerves waking up…Good Luck
to you.
I had a small red spot on my nose in early March. I had gone to my Derm for a planters wart and asked her to look at the spot while I was there.
She was in a hurry and briefly glanced at my nose, gave me a cream and told me it would go away. My next appointment was two months later at which time the spot had changed in color and size. I again brought it to my Dr's attention. This time she said she needed to do a biopsy.
Approximately three weeks later my Dermatologist confirmed that it was indeed bcc, and asked me when I had first noticed the spot? I reminded her it was at my appointment with her in early March. Suddenly she became very quite, and proceeded to refer me to a MOHS surgeon.
The Mohs surgeon explained that he would do a flap from my laugh line.
I asked about a plastic surgeon and he became upset as if I had damaged his huge ego. He told me to come to his other office to see all of the photos of other patients. I took him up on his offer and was glad I did. After seeing the photos at his office I was depressed and devastated. I had bouts of tears and confusion, and many questions that nobody could answer.
I made the decision to contact a plastic surgeon, one of the best.
On June 25, the plastic surgeon Dr _ preformed my MOHS surgery and reconstruction. My bcc was large and fast growing. My Dr explained that because of the large cancer, it may take up to a year for my nose to look its best. One thing that I haven't heard anyone discuss is a raised bump on their nose. I do have one and I am told to massage it two times a day three minutes each time with either cocoa butter or vaseline.
Although I know that I am not completely restored, the end result with the plastic surgeon is greatly superior to what would have been left by the MOHS surgeon.
MY DERMATOLOGIST RECOMMENDED RADIATION FOR BASAL SKIN CA TIP OF NOSE, LESS THAN 1CM. TREATMENT IS CALLED HDR BRACHYTHERAPY, DEVICE IS MADE BY NUCLETRON, A EUROPEAN COMPANY. SUPPOSEDLY VERY SHALLOW RADIATION PENETRATION, GOOD COSMETIC OUTCOME, AND CURE RATE 98%. CAN ANYONE COMMENT ON THIS VS MOHS. ALTHOUGH I DID TREATMENT #1 THIS EVENING, I'M STILL SHAKY ABOUT DECISION.
Hi! I came across your site in the search for other people that have had Mohs Surgery. I hope all is well with you now, considering this is an old post.
This is my article on my Mohs surgery done to my nose a short time ago.
Link:
stvincentsdarlinghurstmalenurses.blogspot.com/2009/01/skin-cancer-nose-no-boundaries.html
Thanks for sharing,
Peter
Thank you so much for sharing your story and your pictures! Your writing style is very enjoyable to read! I am scheduled to have Mohs surgery in about a month on my upper lip with reconstruction after. I am only 41 and had Mohs when I was 36 on my forehead. I wear bangs, so that wasn't nearly as upsetting as getting the lip verdict. Anyway, I found your story comforting and I guess it just makes me feel less lonely. Thanks so much!
Thanks so much! We have had the same experience, except I am male. They chipped away at the basal cell on my nose, and the defect wasn’t small. I had the same experience with the Dr Plastic; my guy also wasn’t all that reassuring when he saw me either. And then he had me look at the hole in my face in the mirror, and afterward I wished I hadn’t looked. I had plastic surgery the next afternoon, and the results I am told look pretty good, but I am having a tough time dealing with the tenderness, tighness and numbness, combined with the sense of loss of such an intimate friend; ie the face I have lived with for 42 years. It has now been one week since the surgery, and the stitches are out, but I know it is not my nose there but rather a flap of my cheek, and that caused me a little nausea last night.
I too realize that this is a minor thing in comparison to all the horrors one might experience in life, medically and otherwise (ie terminal cancers, horrific accidents, etc), but still, this was a huge thing for me. I just want to feel like myself again.
I do deep down appreciate all the doctors have done for me, in removing the cancer and patching me back up as good as can be expected.
Best of luck to you and thank you again for your post.