Monday, October 12, 2015

The Face

It started out as a little thing. While looking in the mirror about six months ago, I noticed a shiny little bump in the middle of my forehead. "Oh, great," I thought. "I am 34 years old and still breaking out."

After dealing with more than 20 years of pimples, I knew not to try to pop the sucker. It would make it bigger, redder, and last a hell of a lot longer. And since it didn't have an active white head (which I think is pretty much the grossest thing ever), I decided to just let it alone. It would heal on its own and I had a really good foundation to camouflage it.

But it didn't go away. It just stayed there. Covering it up became part of my regular makeup routine. And on the days I didn't wear makeup I just didn't worry about it.

After a while though, the bump began to worry me. I stated making mental notes to call my dermatologist--and of course I immediately forgot these mental notes. I eventually got my act together and called and made an appointment, especially since I had another mole I also wanted to get checked out. About six months after first noticing it, I was finally getting my mystery nodule checked out.

My dermatologist entered the room, glanced at my forehead, and said, "oh, yeah, that's a basel cell. I'm about 99% sure. It's not a big deal, it's not life-threatening, but you will need to have some surgery." She gave me the basics of the procedure, gave me a brochure, and a referral to a skin cancer surgery center.

I was familiar with basel cell carcinoma through my job reviewing medical disability claims for the VA. It's the most common form of cancer and is very rarely life-threatening. The tumors, which usually present as a new mole or shiny bump, don't metastasize, but the cancer will continue to grow and the tumor will get bigger if it is not removed. So my bump needed to come off. I started calling it my unicorn horn.

I read about BCC and the procedure (called Mohs micrographic surgery) and pretty much figured it would be no big deal. There might be some stitches, but if the amount of skin that needed to be removed was small enough I might not even need that. I was nervous, and a bit concerned about the pain, but I figured I could handle it. To put it another way, I was optimistic.

Boy, was I unprepared. Mentally, I mean. The way the surgery works is you go back in the room and after a topical anesthetic, the doctor removes the bump. It then goes to an on site lab and they try to find a good margin of distance between the cancer cells and the healthy cells. Best case scenario: they get the desired margin on the first try and then you might not even require stitches.

This is not what happened in my case.

I had to get cut twice before the doctor was happy with the results. Apparently I had "roots of the cancer spreading into my hairline." Great. Not only was the cutting part awful, but then I had to get stitched up. I had to get extra doses of anesthetic (probably because I am a ginger) and was awake for every cut, tug, pull, and stitch that went into my forehead. I'll spare you the gory details (too late?) but it was kind of traumatic and way worse than I expected. I left the doctor's office with a huge bandage on my forehead and a forced smile on my face.

Recovery was hard too. There was a lot more pain that I expected and I had to leave the large bandage on for 24 hours, at which point it could come off leaving a water proof under-bandage which was still pretty big. That would remain on for a week and the doctor would remove it at my week follow-up appointment. That one went off without a hitch, and I had some small butterfly bandages for the next few days. After that I was bandage free, but would have to deal with my scar.

I've never considered myself a vain person. Of course I care about the way I look--and of course I have major body issues (I spent the first 30 years of my life as a fat girl, so yeah). But for the most part I think I have a fairly realistic idea of how I look and don't spend too much time worried about whether I am pretty or whether the face I present to the world is attractive enough.

But having someone cut into my face and having to look at a 2 inch scar on my forehead for the rest of my life has hit me really hard.

There was almost a sort of mourning period for my former face. It wasn't flawless and I actually had some tiny scars from childhood incidents, but I've never had anything like this before. It's large, obvious, and raised above the skin level. Think of the cliche Frankenstein-type scar, and you're not too far off. Though my stitches (which will dissolve) are thankfully flesh colored and not black.

Because the forehead has to support the weight of the face, the doctor had to raise the scar; otherwise, it would pull open as the skin dropped down. The surgeon said that it would look like "taffy." Gross. He also had to put a sizable dent into my forehead. This is actually some stitches under the skin holding up the muscles of the forehead until they are used to supporting the extra weight of the scar tissue. So not only do I have a raised scar, I also have a dent. Swell.

I want to take a break from my whining and give a shout-out to my surgeon. The folks over at the Skin Cancer Surgery Center (offices in Fairfax and Bethesda) were fantastic. Very professional, kind, and skilled. Aside from the long waiting time, I have no complaints.

The good news is in about a year this will all all fade and I will have a "barely visible" line in my forehead that should essentially disappear into a normal crease. The bad news is, it's going to take a year to get to that point.

So here I am, trying to adjust to my new face. It's a shock and kind of sad to look into the mirror now. I'm a bit ashamed to admit that to the world--remember when I said I had never considered myself a vain person?I think I might have to readjust how I think about that too. I know objectively that soon the scar will fade and most people will never know it is there. I also know objectively that the surgery needed to be done; better to have a manageable amount of pain now and nip this problem in the bud. But I also know that subjectively I am still mourning my former face.

Remember to wear your sunscreen, ok? Because you really don't want to go through this. But I am still very grateful that it wasn't worse and I will have a full recovery. I am luckier than most.

And now, the pictures! If you don't like seeing pictures of scars (or my face, I guess) feel free to skip this part. Nothing is very gross, but hey, just giving the warning.

Big post-surgery bandage and sad face. 

Water-proof bandage (I had this one for a week).

Removal of all bandages in the doctor's office. Check out the dent!

Two weeks post-surgery. Still pretty red. The scar is shiny since I use Vaseline to avoid scabbing. Oh, and the headphones in all these pics are because I took them while working. 

My awesome friend Sarah sent me some fun bandages--these ones are called Oopsie Dasiy!

And here we are today: 3 weeks post-surgery. Still a raised scar and a dent, but the redness has gone done and the stitches have dissolved. So for the next 6 months or so, this is my face.