Mohs surgery removes skin cancer in stages while sparing as much healthy tissue as possible, and it has one of the highest cure rates of any skin cancer treatment. But the days and weeks after the procedure matter enormously for how well you heal and how your scar looks long-term. Certain habits, substances, and well-intentioned mistakes can raise your risk of bleeding, infection, or poor wound closure. What follows covers the most consequential things to avoid once you leave the surgeon’s office.
Don’t Smoke or Use Nicotine Products
If there is one behavior that consistently wrecks surgical outcomes, it is smoking. Tobacco use after Mohs surgery is linked to wound breakdown, tissue death in flaps and grafts, slower healing, and a higher rate of infection.1PubMed. Tobacco smoking and dermatologic surgery The effect is not subtle. One study of Mohs reconstructions using flaps and grafts found that current smokers had roughly ten times the odds of developing acute complications compared with nonsmokers, while even former smokers still carried about three and a half times the odds.2PubMed Central. Association of Smoking and Other Factors With the Outcome of Mohs Reconstruction Using Flaps or Grafts
The reasons are straightforward. Nicotine constricts blood vessels, which chokes off oxygen delivery to the tissue that is trying to knit back together. Meanwhile, carbon monoxide in cigarette smoke binds to hemoglobin and further reduces how much oxygen actually reaches the wound. Together, these effects lower the oxygen concentration in the tissue beneath the skin surface, making flap loss, hematoma, and fat necrosis all more likely.3PubMed Central. Smoking and Flap Survival This applies to all nicotine delivery systems, not just traditional cigarettes. Vaping, nicotine patches, and chewing tobacco all deliver the vasoconstrictor that your healing tissue does not need.
Most Mohs surgeons recommend stopping nicotine products at least a few weeks before surgery and staying off them for several weeks afterward. If you have already had the procedure and are still smoking, stopping now still helps. Every additional day of nicotine exposure during the healing window raises the likelihood that something goes wrong with your wound.
Don’t Stop Blood-Thinning Medications on Your Own
A common instinct is to assume you should stop aspirin, warfarin, or other blood thinners before or after surgery to prevent excessive bleeding. This is one of those cases where the intuitive move is the wrong one. Research on patients undergoing Mohs and other skin surgeries found that continuing blood thinners during the perioperative period was not associated with an increase in surgical complications, while stopping them raised the risk of stroke and cardiovascular events.4PubMed. Controversies in perioperative management of blood thinners in dermatologic surgery: continue or discontinue?
The bleeding from Mohs surgery is almost always manageable with pressure and local measures. A stroke caused by abruptly halting anticoagulation is not. Unless your Mohs surgeon specifically tells you to stop a medication after reviewing your full drug list and consulting with your prescribing physician, keep taking everything as prescribed. If you are unsure, call your surgeon’s office rather than making the decision yourself.
Be Cautious with Supplements, Especially Garlic and Hawthorn
People tend to think of dietary supplements as harmless, but several common ones can alter how your blood clots. A review of the evidence found that garlic and hawthorn supplementation is strongly associated with surgical bleeding, independent of whether you are also taking anticoagulant medications.5PubMed Central. Dietary supplements and bleeding Other supplements that have been flagged for anticoagulant-like effects include fish oil, vitamin E in high doses, ginkgo biloba, and ginger, though the evidence for these varies in strength.
The practical advice is to tell your Mohs surgeon about every supplement you take, including herbal teas and concentrated extracts, well before your procedure. In the days after surgery, continuing to take supplements that thin the blood can contribute to persistent oozing, bruising, or hematoma formation under the wound. Your surgeon may ask you to hold certain supplements for a specific window before and after the procedure. Follow those instructions even if the supplement feels benign.
Avoid Alcohol in the First Few Days
Alcohol is a vasodilator, meaning it widens blood vessels and increases blood flow to the skin surface. After Mohs surgery, that translates to a higher chance of bleeding and swelling at the wound site. Even a moderate amount of alcohol in the first 48 hours can undo the hemostasis your surgeon achieved with careful cauterization and pressure. Beyond the bleeding risk, alcohol impairs your immune response and interferes with sleep quality, both of which matter when your body is trying to repair a surgical wound.
Most surgical teams recommend avoiding alcohol for at least 48 to 72 hours after the procedure, though some extend that window to a full week, especially for larger or more complex reconstructions. If you are also taking prescription pain medication, alcohol on top of it is a separate safety concern entirely.
Don’t Disturb the Pressure Bandage Too Early
Your surgeon will apply a pressure dressing before you leave. This bandage serves a purpose beyond keeping the wound clean: it compresses the tissue to minimize bleeding and swelling, and it holds wound edges in place while the earliest phase of healing begins. Removing it too early, peeking underneath, or adjusting it because it feels tight can restart bleeding and introduce bacteria.
Instructions vary by practice, but a common protocol is to leave the initial pressure bandage untouched for 24 to 48 hours. When it is time to change the dressing, you will usually be told to do it gently, often after moistening the old bandage with clean water or saline to prevent it from tearing away new tissue. Resist the urge to check on the wound before the recommended time. It will look alarming regardless, and opening the dressing to look accomplishes nothing helpful.
Don’t Exercise, Lift, or Bend Over
Strenuous physical activity raises your blood pressure and heart rate, which pushes more blood toward your wound. For Mohs sites on the face or scalp, even bending over to pick something up off the floor can create enough pressure to restart bleeding or cause swelling under a flap. The risk is highest in the first 48 hours but remains relevant for one to two weeks depending on the size and location of your wound and how it was closed.
Activities to avoid typically include:
- Heavy lifting: anything over about ten pounds in the first week, and sometimes longer for complex closures.
- Vigorous cardio: running, cycling, swimming, and gym workouts that significantly elevate your heart rate.
- Bending or straining: gardening, housework that involves reaching overhead, and straining on the toilet (a stool softener can help if constipation is likely from pain medication).
- Contact sports: anything that risks a bump or blow to the surgical area.
Walking at a casual pace is generally fine after the first day, and many surgeons encourage gentle movement to maintain circulation. The goal is to avoid anything that makes your face feel flushed or your pulse pound. If you feel throbbing at the wound site during any activity, stop immediately and rest with your head elevated.
Don’t Sleep Flat
For wounds on the head, face, or neck, sleeping with your head at heart level lets fluid pool in the surgical area overnight. You may wake up with noticeably more swelling, bruising, or even bleeding that soaked through the bandage. Sleeping propped up on two or three pillows, or in a recliner, for the first few nights makes a real difference in how the wound looks and feels the next morning.
If your Mohs surgery was on a limb, the same principle applies in reverse: elevating the arm or leg above heart level when you rest helps control swelling. Gravity is free and it works.
Don’t Expose the Healing Wound to Sunlight
Fresh scar tissue is far more vulnerable to ultraviolet damage than normal skin. Sun exposure on a healing Mohs wound can cause permanent darkening of the scar, making it more visible long after the wound itself has closed. UV light also slows the remodeling process that gradually makes scars softer and flatter over time.
While the wound is still bandaged, the dressing provides some protection, but once you transition to open wound care or the site has closed over, you need to be deliberate about sun protection. A broad-spectrum sunscreen with SPF 30 or higher should go on the healed scar daily for at least a year, and a wide-brimmed hat is even better for facial sites. Many dermatologists consider sun avoidance on the scar the single most controllable factor in how good or bad the final cosmetic result looks.
Don’t Apply Hydrogen Peroxide, Rubbing Alcohol, or Antibiotic Ointments Unless Told To
There is a lingering instinct to “clean” a wound with hydrogen peroxide or rubbing alcohol, but both are cytotoxic to the new cells trying to grow across the wound bed. They damage healthy granulation tissue and can actually slow healing rather than help it. Most Mohs aftercare protocols call for gentle cleaning with plain water or dilute saline, followed by a thin layer of plain petroleum jelly to keep the wound moist.
Antibiotic ointments like bacitracin or neomycin are a separate issue. Some surgeons prescribe them, but others avoid them because a meaningful percentage of people develop contact dermatitis from these products, especially neomycin. The resulting red, itchy, weeping rash looks a lot like an infection, which can lead to unnecessary antibiotic prescriptions and worry. Unless your surgeon specifically prescribed a topical antibiotic, plain petroleum jelly is usually the safer default. If you notice redness and irritation worsening after applying a product, stop using it and call your surgeon.
Don’t Ignore These Warning Signs
Some post-operative discomfort is normal: mild soreness, swelling, bruising, and a small amount of oozing through the bandage in the first day. What is not normal, and should prompt a call to your surgeon, includes:
- Expanding redness: a growing ring of red skin around the wound that spreads rather than stays put, especially if it feels warm or tender.
- Pus or foul smell: yellow-green drainage with an odor is different from the clear-to-slightly-bloody fluid that normally seeps from a fresh wound.
- Fever: a temperature above 100.4°F (38°C) in the days after surgery suggests your body may be fighting an infection.
- Bleeding that won’t stop with pressure: if you apply firm, steady pressure for 20 minutes and the wound is still actively bleeding, you need professional help.
- Sudden numbness or inability to move part of your face: this is uncommon but can happen when tumors near certain nerve pathways require extensive tissue removal. Research on Mohs surgery near the temporal branch of the facial nerve found that complications were more likely with larger tumors and defects, while no nerve damage was seen when the wound measured under two centimeters.6PubMed. Damage to the Temporal Branch of the Facial Nerve From Mohs Micrographic Surgery
It is worth noting that normal post-surgical swelling and redness are commonly mistaken for infection. The wound will look worse before it looks better. Bruising can travel with gravity, so a forehead wound may produce bruising around the eyes a few days later, which is unsettling but usually harmless. The key distinction is whether things are improving day by day or getting progressively worse. Worsening is the signal to call.
Don’t Get the Wound Submerged in Water
Showers are generally fine after the first bandage change, as long as you keep the stream indirect and pat the wound dry gently afterward. What you want to avoid is submerging the wound in standing water: baths, hot tubs, swimming pools, lakes, and oceans. Standing water harbors bacteria, and a fresh surgical wound is an open door. Pool chlorine is not a substitute for sterile conditions, and ocean water is teeming with organisms you do not want in a healing wound.
Most surgeons ask you to avoid submersion for at least two to three weeks, or until the wound has fully closed and any sutures have been removed. If you are an avid swimmer, this is one of the more frustrating restrictions, but the risk of a serious wound infection is not worth the tradeoff.
Don’t Apply Makeup or Skincare Products to the Wound
It is understandable to want to cover a facial wound with concealer or foundation, especially if you need to return to work or social life. But applying cosmetics directly onto or immediately adjacent to an open or freshly closed wound introduces pigments, fragrances, preservatives, and bacteria from applicators into tissue that has no intact skin barrier to protect it. This increases the risk of both infection and contact irritation.
Wait until the wound has fully closed and any scabbing has resolved before applying makeup over it. For most Mohs wounds, that means at least two to three weeks, though your surgeon may clear you sooner or later depending on how you are healing. When you do start wearing makeup over the scar, use clean applicators and consider mineral-based products with fewer irritating ingredients. Retinoids, glycolic acid, and other active skincare ingredients should also be kept away from healing skin until your surgeon says otherwise, as they can thin the new tissue or cause chemical irritation that disrupts the repair process.
The Timeline Varies by Wound Type
Not all Mohs wounds are the same, and the restrictions above apply on a sliding scale. A small wound closed with simple stitches on the arm will have a shorter list of restrictions and a faster return to normal activity than a large nasal reconstruction involving a flap or graft. Flaps and grafts have their own blood supply considerations and are more delicate in the early healing period, which is part of why smoking carries such outsized risk for those closures.2PubMed Central. Association of Smoking and Other Factors With the Outcome of Mohs Reconstruction Using Flaps or Grafts
Wounds left to heal on their own without stitches, called second intention healing, follow a different arc entirely. They take longer to close, require more frequent dressing changes, and may need to be kept moist with petroleum jelly for weeks. The activity and submersion restrictions generally extend until the wound bed has fully re-epithelialized, which can take several weeks for larger defects. Your surgeon’s written aftercare sheet is the most reliable guide for your specific wound, and when in doubt, a quick phone call to the office beats guessing.