Strategies to improve facial scars following Mohs micrographic surgery

Mohs micrographic surgery (MMS) is the gold standard treatment for skin cancers of the face, but scarring in these cosmetically sensitive areas remains a challenge, with no clear consensus on the most effective treatments. This study reviews the literature on therapies for specifically facial scars following Mohs surgery, emphasizing their mechanism of action and evidence of efficacy. Non-invasive options such as topical silicone and pressure therapy have shown benefits, while advanced techniques like dermabrasion, microneedling, or energy devices like the pulse-dye, CO2, Erbium, and Nd:YAG lasers, show promise in improving scar pliability and visibility. Intralesional injections of corticosteroids, botulinum toxin, and dermal fillers also have supportive data. Conversely, treatments like topical onion extract and vitamin E lack evidence of efficacy. Managing hypertrophic granulation tissue (HGT) also remains critical to reduce aberrant scarring from second-intention healing (SIH). To ensure optimal clinical outcomes, clinicians should remain updated on the wide range of scar therapies available, focusing on those with established biochemical mechanisms and evidence of efficacy.