Mohs micrographic surgery is a precise technique used to remove skin cancer while sparing the maximum amount of healthy surrounding tissue. Since the procedure often takes place on the face, patients frequently have concerns about the appearance and duration of post-operative swelling. Swelling is a normal and expected biological response to surgery, indicating that the body’s healing process has begun. Understanding the typical timeline and influencing factors helps manage expectations during recovery.
The Typical Swelling Timeline
Swelling begins immediately following the procedure as the body initiates an inflammatory response at the surgical site. This fluid collection is part of the natural process that brings healing cells and proteins to the wound area. The most noticeable swelling usually occurs within the first 24 to 48 hours after surgery.
Swelling typically reaches its maximum size, or peak, around 48 to 72 hours post-procedure. The face may appear noticeably puffy, and swelling near the eyes, nose, or forehead can temporarily cause eyelids to swell shut. This peak represents the height of the inflammatory response and is a predictable part of recovery.
Following this peak, a gradual reduction in swelling begins. The majority of major swelling subsides over the next few days, with most patients seeing marked improvement by the end of the first week. By the 7 to 10-day mark, noticeable puffiness has often resolved, allowing stitches to be removed.
Minor or residual swelling can linger for a longer period, especially if reconstruction involved significant tissue movement or grafting. A subtle firmness or slight puffiness may persist for two to four weeks. Full resolution of all soft tissue swelling can take several months, particularly if the procedure involved extensive reconstruction or was in an area with delicate tissue like the nose or eyelids.
Factors Influencing Swelling Duration
The time it takes for facial swelling to resolve depends heavily on several factors specific to the patient and the procedure. The location of the surgery plays a large part; areas like the forehead, eyelids, and nose tend to swell more significantly than the cheeks or jawline. This is due to thinner skin and underlying tissue structure, allowing fluid to collect more easily.
The size and depth of the wound created by cancer removal directly affect the level of tissue trauma and subsequent swelling. Larger defects requiring more extensive repair result in a greater inflammatory response and a longer period of swelling. The method used to close the wound is also a factor in recovery time.
Wounds closed with a simple linear suture generally swell less than those requiring complex reconstruction, such as a skin graft or a flap procedure. Grafts and flaps involve transferring tissue, which can prolong the healing process and result in swelling that takes many weeks or months to fully flatten. Individual patient health, including age and circulation, also influences the body’s ability to clear accumulated fluid and contributes to variations in recovery time.
Strategies for Reducing Facial Swelling
Patients can take several proactive steps to minimize facial swelling and improve comfort during initial recovery.
Head Elevation
Elevating the head is one of the most effective strategies, particularly when resting or sleeping. Keeping the head propped up on extra pillows or sleeping in a recliner helps gravity assist in fluid drainage away from the face.
Cold Compression
Applying cold compression is beneficial in the first 48 hours following the procedure, when swelling is building toward its peak. A cold pack, wrapped in a thin towel, should be applied gently for 15 to 20 minutes at a time, several times a day. Avoid placing ice directly onto the skin or surgical site to prevent tissue damage.
Sodium Restriction
Limiting dietary sodium intake is helpful, as high sodium levels cause the body to retain excess fluid, contributing to swelling. Consuming no more than 1500 to 2000 milligrams of sodium per day is often recommended post-operatively to promote a diuretic effect. Avoiding processed and prepared foods, which are hidden sources of high sodium, helps meet this goal.
Activity Restriction and Pain Management
Activity restriction is essential because strenuous activity, heavy lifting, or bending over can increase blood pressure to the head and exacerbate swelling or risk bleeding. Surgeons typically advise limiting vigorous physical activity for at least the first week to allow initial wound healing without complication. For pain management, over-the-counter acetaminophen is recommended, as NSAIDs like ibuprofen are often advised against immediately after surgery due to potential effects on bleeding.
Recognizing Abnormal Swelling and Complications
While some swelling is normal, patients should be vigilant for signs indicating a complication requiring medical attention. Swelling that worsens dramatically after the expected 72-hour peak, or swelling that is rapid and localized, is a cause for concern. Asymmetrical swelling, where one side of the face is significantly more swollen than the other, should be reported to the surgeon.
Signs of infection usually include increasing redness that spreads outward from the wound, warmth to the touch, and a persistent fever. The presence of pus or a cloudy discharge from the surgical site is a clear warning sign. These symptoms often appear a few days after surgery and should prompt immediate contact with the surgical team.
Another concern is the development of a hematoma, which is a collection of blood under the skin. A hematoma may present as a firm, painful lump or a rapidly expanding bruise. Though minor bruising is common, a sudden, large increase in swelling accompanied by significant pain should be evaluated promptly to ensure the integrity of the wound repair.