Randolph Dermatology and Mohs Micrographic Surgery

Instructions After Surgery

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About David J. Najarian, M.D.

For the day of your surgery:

Keep the surgical site dry and protected.


For the next day and subsequent days until you return to our office:

Soak the dressing in the shower and gently remove the dressing. 

Wash your hands with soap and water.  Then gently cleanse the surgical site with one of the following: soap and water, hydrogen peroxide, white vinegar (1 tablespoon in 1 pint of water), or hibiclens (available in pharmacies) using fresh gauze or Q tips.  Hydrogen peroxide works particularly well to dissolve any crusts that have formed around the surgical site (but please do not forcefully pick off any adherent crusts--this could cause bleeding).  Never use hibilens around the eyes.  If you were told that all the sutures would dissolve on their own and that you would not have to have sutures removed, however, please use hibiclens or soap and water only to cleanse the surgical site (vinegar and hydrogen peroxide will prematurely dissolve those types of stitches). 

Once the wound is cleansed, apply vaseline (or other ointment, such as mupirocin, bacitracin, polysporin, or neosporin) to the surgical site with a fresh Q tip.  Moist surgical sites heal faster, and dry surgical sites heal slower, so keep it moist.  Also use the Q tip to gently remove any crust that is forming over the surgical site (but do not force very adherent crust off).  Finally apply a two layer bandage:  a fresh non stick pad (also called non-adherent pad, or "Telfa") goes on the wound first, and this is covered with regular cloth gauze, and finally covered with "first aid" cloth tape.  If the surgical site is small enough, and nothing is draining from it, you may simply apply a large bandaid over the wound.  


Special Considerations

Do not smoke when you go home.  Smoking deprives your skin of oxygen, which is needed for healing.  

When you go home, add crushed ice into a zip lock bag and wrap in a cloth.  Then apply firmly to the surgical site to reduce pain, swelling, bleeding, and bruising. 

Unless you have liver disease and cannot tolerate tylenol, tylenol is generally the safest medicine to take for post operative pain.  Other pain medicines may thin your blood and increase your chances for bleeding.  

If the dressing gets wet or falls off it should be replaced (as described above).

Bleeding is sometimes seen after surgery.  If you notice bleeding through your bandage, fold some 4 by 4 inch gauze pads in half and in half again, and press firmly onto the surgical site for 20 minutes (without peaking).  After 20 minutes, remove the dressing and check the wound.  If it is still bleeding, repeat the firm application of gauze to the surgical site for another 20 minutes.  If the site is still bleeding call Dr. Najarian at 973-366-6303 or go to the closest emergency room.

If you develop severe pain or swelling around the surgery site you could be developing a hematoma (collection of blood under the skin).  Please call us immediately for advice if this happens.  You may need immediate treatment.

If you develop a red, itchy rash at the surgery site, you may be developing a skin allergy to the antibiotic ointment or dressing tape.  Consider stopping the use of antibiotic ointment and using vaseline only (which will not cause a skin allergy).

If you develop pain, redness, swelling, warmth, pus, or foul odor at the surgery site you could have an infection.  Please call us immediately if this happens.  You may need oral antibiotics.  

If your surgery was on your face or head, please try and keep your head elevated for the next 48 hours.  Bending down causes blood to rush to your face and head and may increase the likelihood of bleeding from the surgical site.  Elevate your head on 2-3 pillows at night if possible.

If your surgery was below your knee you can expect redness and swelling to persist at the site for several weeks.  You can reduce redness and swelling by keeping your leg elevated when you are sitting down.  Purchasing a seat cane (available at surgical supply stores) may be useful for this purpose, especially when you plan to leave your house.  Ice packs will also help reduce redness and swelling.  An excessive amount of walking around or standing on your feet after the surgery can lead to increased pain, redness, and swelling for a surgery site below the knee.   

If your surgery was around your mouth, please eat only soft foods for 3 days after the procedure.  Opening your mouth too wide or stretching your lips while eating something large or firm can cause the surgical site to bleed.  

Avoid strenuous exercise that could increase your pulse or blood pressure, or could pull apart your stitches for approximately 3 weeks after the procedure.

Wear only clean clothes over the surgery site to decrease the likelihood of acquiring a skin infection at the surgery site.  

If your surgical site was left to heal naturally (without sutures), you will cleanse the wound and change the dressing daily until the site is completely healed over.  Completely healed wounds are pink and completely smooth.  They are not covered with scabs, and they do not leak fluid.  Most naturally healing wounds require 2-3 weeks to heal.  Surgical sites below the knees may take significantly longer to heal.  Naturally healing surgical sites may heal with a light color compared with surrounding skin.  

Surgical scars tend to look better and better over the course of an entire year.  After your sutures are out and Dr. Najarian has examined the site, you may discuss with him the possibility of treating the scar to improve its appearance.  Massaging the scar with your finger periodically throughout the day for several months may help soften and flatten the scar.  Silicone sheets may also help soften and flatten scars.  These sheets are typically taped to the surgical site at night and removed in the morning.  They are typically utilized for 4-6 months for best results.  See the "Recommended Products" link on our home page to learn more about silicone sheet products.     

Call Dr. Najarian with questions at any time at 973-366-6303.

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