Will I have a scar after facial skin cancer surgery?

Traditional reconstruction with skin grafts or flaps can leave visible scars and tissue that differs in color or texture from facial skin. Ellacor micro-coring uses thousands of microscopic grafts taken from your own facial skin, which blend seamlessly with the surrounding tissue and result in minimal visible scarring.

What is Ellacor micro-coring?

Ellacor Micro-Coring Technology harvests thousands of full-thickness skin grafts about 400 microns in diameter (less than half a millimeter) and packs them into the Mohs defect. Originally used for cosmetic skin tightening, it was adapted by Dr. Arthur E. Desrosiers III for post-Mohs reconstruction.

How long does healing take after Ellacor reconstruction?

Donor sites typically heal within 3 to 5 days, and first-stage healing of the recipient site usually takes 14 to 21 days. Over the following two to three months the area continues to blend with surrounding skin. Most patients return to work the next day, with social downtime averaging about five days.

Who is a good candidate for Ellacor micro-core reconstruction?

It is particularly beneficial for patients seeking natural-looking reconstruction with minimal scarring, especially for skin cancer in cosmetically sensitive areas such as the nose, cheeks, under-eye region, or midface. A personalized consultation determines suitability based on the size, depth, and location of the defect.

Scarless Facial Reconstruction After Skin Cancer Surgery

Q: What is Mohs surgery and why is it used for facial skin cancer?

Mohs micrographic surgery removes skin cancer in thin, horizontal layers, examining each layer under a microscope to confirm clear margins while sparing as much healthy tissue as possible. Its high cure rates and tissue-sparing precision make it the gold standard for skin cancer on the face.

Q: Will my face look different or disfigured after the procedure?

Because Ellacor grafts come from your own facial skin and the technique preserves facial contours and aesthetic subunits, it is designed to maintain a natural appearance. This avoids the contour distortion and donor-site mismatch that can occur with traditional flaps and distant skin grafts.

When patients learn they have skin cancer on their face, they often have questions such as:

“Will I have a scar after the surgical removal of the cancer?”
“What is Mohs surgery and why is it used for facial skin cancer?”
“Will my face look different or disfigured after the procedure?”

Historically, the gold standard for surgical removal of skin cancer on the face is a technique called Mohs micrographic surgery (MMS). Mohs surgery is highly effective because it spares healthy tissue while achieving high cure rates.¹ During the procedure, the surgeon removes the tumor in thin, horizontal layers, similar to slicing a loaf of bread. Each layer is examined immediately under a microscope to check the edges and confirm that all cancer cells have been removed while preserving as much healthy tissue as possible.² If any cancer cells are detected, the surgeon removes additional tissue only where needed.

This precise approach minimizes the need for multiple procedures and helps ensure that the patient leaves with the entire tumor successfully removed. While Mohs surgery preserves healthy tissue, reconstructing the resulting defect presents a separate challenge: restoring both function and a natural appearance.

After Mohs Surgery: Traditional Reconstruction Techniques

After Mohs surgery for facial skin cancer, the cancerous tissue is removed, leaving a small hole in the skin. Traditionally, surgeons repair this with full-thickness skin grafts or flaps (transfer of adjacent tissue in the face).

Full-thickness skin grafts involve harvesting the entire epidermis and dermis from commonly used donor sites including the postauricular, preauricular, supraclavicular regions, or the superior tarsal eyelid.² Skin taken from behind the ear or collarbone may appear lighter, thicker, or different in texture compared to facial skin. This may lead to unnatural or poorly aesthetic appearing results.

While flaps provide a reasonable tissue match and generally reliable healing, they rarely achieve perfect integration, and significant limitations remain. Often, these techniques may require additional incisions and can generate secondary deformities, such as contour distortion and dog-ear formation.^9,2 For patients concerned about cosmetic outcomes, especially in central facial areas like the nose, these differences can be easily noticeable.

Why Traditional Reconstruction Can Be Problematic

A majority of skin cancers develop in sun-exposed regions, including the face, neck, and upper extremities.¹ The challenge comes during reconstruction. After Mohs surgery, defects are traditionally repaired with highly invasive skin grafts or flaps.^2,9 While these methods effectively close the wound, they often result in large visible scars at both the defect and donor sites, and the skin may differ in thickness, texture, or sun damage compared to the facial tissue being repaired. Reconstruction is essential not only to restore function but also to achieve aesthetic results in these visible areas of the body that directly influence long-term patient satisfaction and quality of life.^3,4

Flaps can also alter natural facial contours, particularly in areas like the nose, cheeks, and midface, which may be noticeable to the patient.^2,9 For many patients, these visible differences can lead to significant psychosocial impact, especially when the defect is in a highly visible location.^3,4

A Minimally Invasive Option: Ellacor Micro-Coring Technology

An innovative approach using micro-core skin grafting with the Ellacor® System offers a minimally invasive option for aesthetically-pleasing post-Mohs reconstruction. This groundbreaking technique repairs the skin while blending the scar seamlessly with surrounding tissue.

What is Ellacor?

Ellacor® Micro-Coring Technology involves harvesting thousands of microscopic, full-thickness skin grafts, about 400 microns in diameter (less than half a millimeter). While Ellacor is classically used for cosmetic skin tightening and wrinkle reduction, Dr. Arthur E. Desrosiers III pioneered its use in reconstructive surgery to repair post-Mohs defects.^7,13,14

Instead of harvesting a single full-thickness skin graft from a distant site or creating a flap that may alter facial contours, Ellacor involves harvesting thousands of tiny skin grafts to be redistributed across the Mohs defect. Because the grafts come from the patient’s own facial skin, they closely match the surrounding tissue and integrate seamlessly within the surgical site.^7,13,14

Key Benefits of Ellacor

There are several advantages to Ellacor. The harvested skin comes from the same facial region as the defect, generally from the pretragal area down to the gonial angle, across the malar region, and lateral to the oral commissure or chin. This is important because studies show that the nose is by far the most common site for facial skin cancers, followed by the eyelids, ears, and cheeks, meaning defects often occur in highly visible areas where local skin more closely matches the surrounding tissue.¹⁷ This ensures a natural color, texture, and thickness match to the recipient site. Unlike traditional techniques, which may leave disfiguring scars or require tissue from distant donor sites, Ellacor results in minimal visible scarring, preserves facial contours, and eliminates donor-site morbidity. By densely packing thousands of tiny grafts into the defect, the technique avoids the need for large flaps or grafts, preventing disfiguring scars and preserving the integrity of facial aesthetic subunits.

Regenerative Mechanism

The microscopic full-thickness cores harvested by the Ellacor device include epidermis, dermis, adnexal structures, dermal fibroblasts, and stem cells.^7,13,14 These micro-grafts act as biologically active islands within the wound bed, promoting localized epithelialization and supporting dermal regeneration. By distributing thousands of these grafts across the defect, multiple epithelialization centers are created, encouraging uniform healing and improved contour integration.^¹¹

To further enhance regenerative potential, Dr. Desrosiers applies liquid amnion, a biologically active amniotic membrane extract, over the grafts.¹⁶ Rich in growth factors, extracellular matrix proteins, and anti-inflammatory cytokines, liquid amnion supports angiogenesis, epithelialization, and fibroblast proliferation while limiting fibrosis and excessive inflammation.¹⁶ This combination of Ellacor and amnion promotes uniform skin coverage, minimizes postoperative scarring, and—thanks to the heat-free mechanism of Ellacor—reduces the risk of pigmentary changes, making it ideal for patients prone to dyspigmentation or scarring.

Technical Advantages and Rejuvenation Potential

The procedure’s adjustable depth and treatment density allow precise micro-core harvesting, even in anatomically sensitive regions with thinner dermis or important vascular structures. Harvesting from the midface also provides skin tightening, offering simultaneous aesthetic facial rejuvenation alongside reconstructive repair. Prior studies demonstrate measurable improvements in dermal thickness and skin tightening following treatment.¹⁵ The fractional pattern of micro-core removal pattern promotes dermal remodeling, which may further improve skin texture at the donor site. Together, these technical and biologic features support both precise reconstruction and midface rejuvenation, providing an integrated solution for post-Mohs facial defects.

Ellacor Micro-Coring

The device’s tiny hollow needles remove microscopic, full-thickness skin cores about 400 microns in diameter (less than half a millimeter!) Micro-cores are collected in a sterile filter and then densely packed into the surgical defect where the skin cancer was removed. Healing is often supported with liquid amnion, a biologically active extract that promotes tissue regeneration, reduces inflammation, and accelerates graft integration. As a result, the skin naturally shrinks and tightens as the donor sites heal.

Fast Wound Healing

Healing occurs in stages and each patient experience may vary slightly. The donor sites typically heal within 3-5 days, while the first stage healing of the recipient site (i.e. Mohs where the cancer was removed) usually takes 14–21 days. Over the next two to three months, the reconstructed area continues to blend seamlessly with the surrounding skin, producing the final cosmetic result. Postoperative care involves gentle cleansing with a mild cleanser, such as Cetaphil or baby shampoo, followed by the application of petrolatum jelly for several days to lock in moisture and protect the area. Sun protection is critical during healing to prevent pigment changes and reduce the risk of future skin cancer. Most patients can return to work the next day, with social downtime averaging around five days, which is when makeup can comfortably be applied. We have amazing aesthetic results with long-term follow-up of over 2+ years.

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Ideal Candidate for Ellacor

Ellacor micro-core grafting is particularly beneficial for patients seeking a natural-looking reconstruction with minimal visible scarring. This technique is suitable for patients with skin cancer in cosmetically sensitive areas of the face, including the nose, cheeks, under-eye region, or midface, where maintaining natural contours and a seamless skin match is essential for the best aesthetic outcome.

Ultimately, a personalized consultation is necessary to determine whether this method is appropriate, as suitability depends on factors including the size, depth, and location of the surgical defect, as well as individual healing considerations.

Coordinating Cancer Removal and Reconstruction

Reconstruction is performed only after clear margins are confirmed, ensuring that no cancer remains at the edges of the removed tissue. Temporary dressings protect the surgical site until the Ellacor reconstruction can be performed, often the following day.

Dr. Desrosiers’ innovative use of Ellacor micro-core grafting represents a minimally invasive way to rebuild the face after Mohs surgery, offering natural-looking results, faster healing, and minimal scarring.

Ready to Explore Your Options?

If you’re worried about a suspicious growth and/or already have a diagnosis of facial skin cancer and are concerned about visible scarring, a personalized consultation can help you understand your options for scarless facial reconstruction.

To learn more or schedule a consultation, contact our office today, schedule a consultation or call 305-403-2922, or email us at concierge@ArthurMD.com. Our office is conveniently located in Coral Gables, Miami, FL.

[1] Li H, Wang R, Zhou J. Global, regional, and national trends in the burden of melanoma and non-melanoma skin cancer from 1990 to 2021: Results from the Global Burden of Disease Study. BMC Public Health. 2025;25:487. Accessed Mar 1, 2026.

[2] Bittner GC, Cerci FB, Kubo EM, Tolkachjov SN. Mohs micrographic surgery: A review of indications, technique, outcomes, and considerations. Anais Brasileiros de Dermatologia. 2021;96(3):263–277. Accessed Mar 2, 2026.

[3] Gulati A, Grekin R, Neuhaus I, et al. Long-term appearance-related outcomes of facial reconstruction after skin cancer resection. Facial Plast Surg Aesthet Med. 2023;25(4):344–350. Accessed Mar 2, 2026.

[4] Strohl M, Sweeny L. Advances in midface reconstruction. Facial Plast Surg Clin North Am. 2025;33(1):57–65. Accessed Mar 6, 2026.

[5] Garg N, Vaile JR, Amin D, et al. Evaluating the effects of timing of reconstruction of facial Mohs defects for nonmelanoma skin cancer on complications using data from a global aggregate health care network. Facial Plast Surg Aesthet Med. 2025;27(4):344–349. Accessed Mar 6, 2026.

[6] Bascone CM, Deitermann A, Lin SK, et al. Using Integra for reconstruction of facial defects after Mohs micrographic surgery. Plast Reconstr Surg Glob Open. 2023;11(12):e5474. Accessed Mar 6, 2026.

[7] Pozner JN, Kilmer SL, Geronemus RG, et al. Cytrellis: A novel microcoring technology for scarless skin removal: Summary of three prospective clinical trials. Plast Reconstr Surg Glob Open. 2021;9(10):e3905. Accessed Mar 9, 2026.

[8] Memar O, Caughlin B. Nasal reconstruction of post-Mohs defects >1.5 cm in a single cosmetic subunit under local anesthesia by a combination of plastic surgeon and Mohs surgeon team. Plast Reconstr Surg Glob Open. 2019;7(6):e2277. Accessed Mar 8, 2026.

[9] Losco L, Bolletta A, Pierazzi DM, et al. Reconstruction of the nose: Management of nasal cutaneous defects according to aesthetic subunit and defect size — a review. Medicina. 2020;56(12):639. Accessed Mar 9, 2026.

[10] Sharma AN, Patel BC. Laser Fitzpatrick skin type recommendations. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; Updated March 6, 2023. Accessed March 31, 2026.

[11] Everts PA, Knape JTA. Micrografting in wound healing: Concepts and applications. Int J Burns Trauma. 2010;1(1):1–10. Accessed Mar 12, 2026.

[12] Berman HS, Awe O, Heckman MG, et al. Vascular postoperative changes after facial flap repairs: An opportunity for early intervention. Dermatol Surg. 2024;51(1):5–10. Accessed Mar 12, 2026.

[13] McKenzie J, Smith R, Patel N. Amniotic tissue: Mechanisms of action and clinical milestones in cutaneous wound healing and scar reduction. J Plast Reconstr Aesthet Surg. 2023;76(11):2217–2226. Accessed Mar 12, 2026.

[14] Hassanein AH, et al. Modified keystone perforator island flap techniques for small- to moderate-sized scalp and forehead defect coverage: A retrospective observational study. J Pers Med. 2022;12(12):2067. Accessed Mar 14, 2026.

[15] Strohl M, Sweeny L. Advances in midface reconstruction. Facial Plast Surg Clin North Am. 2025;33(1):57–65. Accessed Mar 15, 2026.

[16] Wainer Mamsen FP, Kiilerich CH, Hesselfeldt-Nielsen J, et al. Risk stratification of local flaps and skin grafting in skin cancer-related facial reconstruction: A retrospective single-center study of 607 patients. J Pers Med. 2022;12(12):2067. Accessed Mar 15, 2026.

[17] Castañeda JM, Chang Grozo SL. Facial reconstruction according to aesthetic units. Eplasty. 2020;20: PMC8061647. Accessed Apr 6, 2026.

Scarless Facial Reconstruction After Mohs Surgery for Skin Cancer: Ellacor Micro-Coring Technology