The First 48 Hours
The first two days after Mohs surgery are the most important for protecting the wound and controlling swelling. Your surgeon will have placed a pressure bandage (a firm dressing) over the repair site before you left the office. This bandage applies gentle pressure to reduce bleeding and protect the wound from bumps and germs. During this period, keep the bandage completely dry. Cover it with a waterproof material such as plastic wrap and tape when bathing or showering, and avoid getting the area wet.
Helpful Tips
- Sleep with your head elevated on an extra pillow if the wound is on your face or scalp. This reduces swelling overnight.
- Apply a cold compress (a bag of frozen peas wrapped in a thin cloth works well) to the area for 15 minutes every hour while awake during the first day. Do not apply ice directly to skin.
- Rest for the remainder of surgery day and take it easy for the first 48 hours.
- Take acetaminophen (such as Tylenol) as directed on the label for any discomfort.
Important
- Do NOT take ibuprofen (Advil, Motrin) or aspirin for pain unless your doctor has specifically told you it is safe. These medicines thin the blood and can increase bleeding.
- Do NOT remove the pressure bandage during the first 48 hours unless you are instructed to by your doctor.
- If the bandage soaks through with blood, apply firm, steady pressure over it with a clean cloth for 15–20 minutes without lifting. If bleeding does not slow, call your doctor.
Daily Wound Care Routine
After the first 48 hours, you will begin your daily wound care routine. This routine should be done once a day. Or as directed by your doctor. Until your sutures are removed or the wound is fully healed. Keeping the wound clean and moist (not dry) is the single most important thing you can do to promote healing and minimize scarring. Dry wounds form hard scabs, which slow healing and increase the risk of a thicker scar. Moist wounds heal faster and more smoothly.
Helpful Tips
- Set a daily reminder on your phone to do your wound care at the same time each day.
- Petroleum jelly is safe on all skin types and does not need to be prescription-strength. Plain Vaseline or Aquaphor from any pharmacy works perfectly.
- Paper tape is gentler on skin than regular surgical tape. Ask for it by name at the pharmacy if you cannot find it.
Step 1: Remove the Old Dressing
Gently peel away the old tape and gauze. If the gauze sticks to the wound, soak it briefly with a little water or saline (salt water) to loosen it before pulling. Do not yank or pull forcefully. Take your time.
Step 2: Clean the Wound
Using clean hands or a soft cotton swab, gently clean the wound with mild soap and water or a wound cleanser recommended by your doctor. Remove any dried blood, crust, or old petroleum jelly from the edges. Rinse well. Pat the area dry very gently with a clean gauze pad or soft cloth. Do not rub.
Step 3: Apply Petroleum Jelly
Using a clean cotton swab or your fingertip (washed hands), apply a thin, even layer of plain petroleum jelly, such as Vaseline or Aquaphor. Directly over the wound and any stitches. This keeps the wound moist, prevents scabbing, and creates a protective barrier. More is not better. A thin layer is all that is needed.
Step 4: Cover with Non-Stick Gauze
Place a non-stick gauze pad (also called a Telfa pad or non-adherent dressing) over the petroleum jelly. Non-stick gauze is important because it will not pull the healing tissue when you remove it. Secure the pad in place with paper tape (a gentle, skin-friendly tape). Change the dressing daily, or sooner if it becomes wet, dirty, or falls off.
Activities and Restrictions
Most patients can return to light, everyday activities within a day or two of surgery. However, certain activities put stress on the wound and can cause stitches to pull apart, bleeding to restart, or the wound edges to separate. Your surgeon will give you specific guidance based on your wound location and repair type. Always follow those instructions first.
Helpful Tips
- Walking and light household tasks are usually fine after 24–48 hours.
- Avoid heavy lifting (anything over 5–10 pounds) for 1–2 weeks or as directed. Straining raises blood pressure in the skin and can cause bleeding.
- Avoid vigorous exercise, running, aerobics, or any activity that causes significant sweating or raises your heart rate significantly for at least 1–2 weeks.
- Avoid bending forward at the waist repeatedly if the wound is on your head or face.
- Ask your doctor specifically when it is safe to return to your exercise routine.
Important
- Do NOT go swimming in pools, hot tubs, lakes, or the ocean until the wound is fully healed and your doctor says it is safe. Soaking a healing wound greatly increases infection risk.
- Do NOT apply makeup, foundation, or any cosmetic product near the wound until your doctor clears you.
- Avoid prolonged direct sun exposure on the healing wound. New scar tissue is especially sensitive to sun damage and can become permanently darker.
Warning Signs of Infection
A small amount of redness, swelling, and tenderness directly around a fresh wound is completely normal for the first few days. However, if these signs get worse instead of better after the second or third day, or if new symptoms develop, it may be a sign of infection. Catching an infection early is important. It is treated simply with antibiotics, but if left too long, it can slow healing and affect your scar.
Important
- Call your doctor promptly if you notice: spreading redness that expands beyond the wound edges, increasing warmth around the wound, yellow or green pus draining from the wound, a fever above 38°C (100.4°F), or severe pain that is worsening rather than improving.
- A mild amount of clear or light pink fluid from the wound in the first few days is normal. Thick or colored discharge is not.
- Do not try to treat a suspected infection at home with over-the-counter antibiotic creams alone. Call your doctor for proper evaluation.
Timeline: What to Expect and When
Recovery from Mohs surgery happens in stages. Understanding the timeline helps you know what is normal at each point and when to expect changes.
| Timeframe | What Is Normal | What to Do |
|---|---|---|
| Days 1–2 | Pressure bandage in place; mild swelling, bruising, and tenderness; area still numb | Keep bandage dry and intact; rest; ice 15 min/hour; take acetaminophen for discomfort |
| Days 3–7 | Daily dressing changes begin; swelling and bruising begin to improve; wound may feel tight or itchy | Follow daily wound care routine; avoid strenuous activity; keep wound moist |
| Days 5–14 | Suture removal (timing depends on wound location. Earlier for face, later for body) | Attend your suture removal appointment; do not try to remove sutures yourself |
| Weeks 2–6 | Wound surface is closed; scar appears red, raised, or firm. This is normal | Continue sun protection; may begin gentle scar massage once approved by your doctor |
| Months 2–6 | Scar gradually becomes softer and flatter; redness fades slowly | Use SPF 30+ sunscreen on the scar daily; continue scar management as directed |
| Months 6–12 | Scar continues to mature and lighten; final appearance not yet reached | Be patient. Most scars look significantly better at 12 months than at 2 months |
Scar Management
All surgical wounds leave a scar. This is a normal part of how the body heals. The goal of scar management is to help the scar become as flat, soft, and light-colored as possible over time. There are several strategies your doctor may recommend, and patience is essential. Scars continue to improve for up to 12 months after surgery.
Helpful Tips
- Sun protection is the single most important scar care step: apply SPF 30 or higher sunscreen to the scar every morning, and reapply if outdoors. Unprotected scars exposed to sunlight can become permanently darker (a condition called post-inflammatory hyperpigmentation).
- Gentle scar massage: once the wound is fully closed and your doctor gives the go-ahead (usually around 4–6 weeks), daily massage of the scar with a small amount of moisturizer for 5–10 minutes can help soften and flatten the tissue.
- Silicone gel sheets or silicone gel applied to a healed scar have good evidence for reducing scar thickness and redness. Ask your doctor if this is appropriate for your wound.
- Avoid picking at or scratching the scar, especially in the early weeks.
- If the scar becomes thick, raised, or itchy months after surgery, ask your doctor about treatments such as steroid injections, laser therapy, or other options.
Important
- Do not apply any scar creams, oils, or vitamin E to the wound until it is fully closed (no open areas). Applying products to an open wound can cause irritation or infection.
- A final scar evaluation is not meaningful before 6–12 months. Do not judge the outcome at 4–6 weeks when the scar is still actively healing.