Who Is Best Qualified to Repair Facial Defects After Skin Cancer Surgery?
How to Choose the Right Expert for Facial Reconstruction
When skin cancer occurs on the face, the stakes are uniquely high. The goal is not only complete cancer removal, but also restoration of function, preservation of facial identity, and an optimal cosmetic outcome. Many patients assume that a facial plastic surgeon or general plastic surgeon is the most qualified specialist to perform these repairs. In reality, for defects created by skin cancer surgery—particularly Mohs micrographic surgery—a board-certified Mohs surgeon and procedural dermatologist is often the most specifically trained and experienced physician to perform facial reconstruction.
Unique Training in Skin Cancer and Facial Reconstruction
A board-certified Mohs micrographic surgeon is first trained as a dermatologist, then undergoes an intensive fellowship focused almost exclusively on skin cancer removal and reconstruction. This training includes:
- Complete understanding of skin biology, wound healing, and scar behavior
- Detailed knowledge of facial subunits, relaxed skin tension lines, and cosmetic units
- Advanced reconstructive techniques tailored to defects of the nose, eyelids, lips, ears, cheeks, and scalp
- High-volume, hands-on experience repairing real-world defects created by cancer removal
In contrast, plastic surgeons are trained broadly across the body. Their expertise is invaluable for many procedures, but skin cancer reconstruction represents a relatively small portion of their overall surgical exposure.
Volume Matters: Daily Experience vs. Occasional Exposure
One of the most important—and often overlooked—factors in surgical excellence is case volume.
A fellowship-trained Mohs surgeon routinely performs 10–20 facial reconstructions per day, every day, year after year. Over the course of training and practice, this amounts to tens of thousands of facial repairs, all performed in cosmetically sensitive and functionally critical areas.
By comparison, even a highly skilled facial plastic surgeon may perform 10–20 skin cancer reconstructions in an entire year. Their practice is typically focused on elective cosmetic surgery, trauma, or larger structural operations rather than the nuanced repair of small-to-medium cutaneous defects created by cancer excision.
Repetition at this level matters. The ability to choose the optimal closure, flap, or graft for a specific defect—on a specific face, with specific skin quality—comes from doing these cases continuously, not occasionally.
Suturing Where the Cancer Is—not Where It's Convenient
Plastic surgeons are traditionally trained to place incisions in concealed locations whenever possible. For example:
- Eyelid surgery (blepharoplasty) hides incisions in natural creases
- Facelifts conceal scars behind the ears or along the hairline
- Cosmetic procedures are designed around pre-planned, symmetric incision
Skin cancer surgery is fundamentally different.
With cancer, the defect is dictated by biology—not by convenience. The surgeon must reconstruct exactly where the cancer was, whether that is:
- The nasal tip
- The medial canthus (inner corner of the eye)
- The vermilion border of the lip
- The alar rim of the nose
- The ear or temple
Suturing in these conspicuous, unforgiving areas—often with limited tissue, altered blood supply, and complex contours—is a distinct skill set. It is not learned from a brief rotation or occasional exposure. It is learned through thousands upon thousands of reconstructions performed under magnification, with millimeter-level precision, where even minor errors can be noticeable for life.
Fellowship Training Built Around These Exact Defects
Mohs fellowship training is unique in medicine. Fellows are immersed full-time in:
- Facial anatomy as it relates to skin cancer
- Local flaps and layered closures tailored to cutaneous defects
- Functional preservation of eyelids, lips, nasal valves, and ear
- Managing wound healing in high-risk and high-visibility areas
This is not a short rotation—it is a dedicated year (or more) focused almost entirely on the removal and reconstruction of skin cancer, most commonly on the face. After fellowship, this experience continues daily in clinical practice.
By contrast, plastic surgeons typically receive limited exposure to skin cancer reconstruction, often as a short component of residency rather than a core focus.
Understanding Skin—Not Just Structure
Because Mohs surgeons are dermatologists first, they bring an additional layer of expertise that is critical for optimal outcomes:
- Predicting scar behavior based on skin type and location
- Managing inflammation, pigmentation, and texture changes
- Preventing and treating hypertrophic scars and poor wound healing
- Optimizing long-term cosmetic results beyond the operating room
Reconstruction does not end when the sutures are removed. Ongoing scar modulation, laser therapy, injectable treatments, and skin-directed care are often essential—and are areas where procedural dermatologists have deep expertise.
The Right Surgeon for the Right Problem
Plastic surgeons play an essential role in medicine and are highly skilled at many complex procedures. However, most facial defects created by skin cancer surgery are best repaired by the physician who removes the cancer and who performs these exact reconstructions every single day.
For patients, the question should not be “Who has the word ‘plastic’ in their title?” but rather:
- Who does this specific surgery most often?
- Who has dedicated fellowship training in skin cancer reconstruction?
- Who understands both the cancer and the cosmetic outcome equally well?
In the vast majority of facial skin cancer cases, the answer is a board-certified Mohs micrographic surgeon with advanced procedural dermatology training
