This includes strenuous physical activity: To ensure a successful outcome from Mohs procedure, it is important for patients to use caution during their recovery phase by avoiding these common post-surgery mistakes. Conditions that are likely associated with a black eye include: Black eyes due to a minor injury can be treated with ice, rest, and pain medication. Mohs surgery is generally considered very safe, but there are some risks: Bleeding from the site of surgery. Mohs Surgery is one of the most effective treatments for skin cancer, but it can leave skin raw, tender, and sensitive afterwards. When they remove it, we recommend applying a diluted white vinegar solution on the wound. Developed in 1938 by Frederic E. Mohs, chemosurgery or simply Mohs surgery is a procedure used to treat different types of skin cancer. Healing from Mohs reconstructive surgery is a process that varies depending on the extent of the surgery. Last reviewed by a Cleveland Clinic medical professional on 08/31/2022. It also offers the highest chance of a complete cure up to 99%. Individual results vary. In general, less than 1% of the margins are checked with wide local excision. • Plan to avoid strenuous physical activity for 2 weeks. Well explain how to treat. You can see how my basal cell carcinoma scar looked a year after this surgery in this . If a skull fracture is suspected, your doctor will order a CT scan and X-ray of your face and head. The procedure has a 98. Sharp eye pain thats sudden is often due to debris in the eye, but it can be. As of yet, President . They may include: Temporary or permanent numbness of the surgical area. • Plan to avoid strenuous physical activity for 2 weeks. If your communication is of an urgent or confidential nature, do not use this form and call us at 781.416.3500. Mohs micrographic surgery involves excision with a smaller margin and the tissue is processed in such a way that your surgeon checks 100% of the deep and side (lateral) margins. A corneal abrasion is a minor scratch on your cornea, the outer clear layer of your eye. Cleveland Clinic is a non-profit academic medical center. What is the typical recovery and downtime from Mohs surgery? We avoid using tertiary references. Alternatively please feel free to send us your request via the patient portal, or via email at info@dermskinhealth.com. In order to keep them calm and relaxed, medications may be given. There is a risk for skin cancer recurrence depending on certain factors such as the size, border, growth rate and location of the tumor. Black eye is also referred to as eye bruises and bruising around the eyes. This is because the skin of theeyelids is very thin, and the orbits are concave and capture dependent bruising. For a possible head injury, you will be referred to a neurosurgeon. How long for recovery? This, A number of patients develop an allergic skin rash after surgery. But if your skin cancer is caught early before it spreads to other areas its possible that youll be cured in a single day with a precise procedure called Mohs micrographic surgery. You can expect minimal discomfort after Mohs surgery; pain can usually be managed well with acetaminophen (Tylenol). It is normal to get some swelling and bruising around the eyelid after Mohs surgery. Swelling and bruising are common after surgery and can last up to 1 month: Surgery on the scalp, forehead and around the eyes can cause the eyes to swell shut for 2-3 days, and give you a black eye for 2 weeks Wounds on the face need to be covered with bandages for 1 week Makeup may be applied only after stiches are removed "*, "After seeing Dr. Krauss for many years, I can't imagine trusting my skin to any other doctor. For basal cell carcinoma, the cure rate is up to 99% for new cases and up to 94% for recurrent cases. Bruising is a normal part of the recovery process after surgery. Closing your wound with stitches (sutures). Removal of the patient's tumor is complicated by the following clinical features: poorly defined clinical tumor borders, large size, clinical area critical for tissue conservation, and located in an area of high recurrence. I went for an annual skin check and she is respectful, friendly, professional. A black eye may be accompanied by other injuries. Tissue conservation is critical in these anatomic locations. "Dr. Norden has a wonderful manner. For this reason it is important to ice the area regularly and keep the head elevated. Problems that can happen during and after Mohs surgery include: Bleeding Pain or tenderness around the places where surgery was done Infection Other problems that can happen are less common. These reactions can create a redness that makes the wound look infected. Most of the time, the condition heals within two weeks. This can usually be controlled by the use of pressure. This is intentional. Therefore, surgeons should be well aware of this entity and techniques that may aid in its prevention. • You may experience a sensation of tightness across the area of your surgery that Dermatologic Surgeon, Board Certified in Dermatology. Take Tylenol (acetaminophen) for pain No alcohol for 48 hours after surgery You may shower and get the area wet 24 hours after the surgery 24 hours after your surgery change the dressing once a day, using the following steps: Gently remove the old bandage How long the procedure takes depends on the tumor itself: bigger, deeper tumors take longer to remove completely. Before and 6 weeks after eyelid skin cancer reconstruction photos are shown. Next an incision was made following the Mohs . In case the defect is on the face, lids, or eye itself, a specialist ophthalmologist with exclusive training in this area will assist in the reconstruction procedure. During black eye recovery, you'll likely see a rainbow of colors within the bruised skin: black-and-blue bruising at first and then changing to green and yellow as you near the . How long it takes for a black eye to heal can be anywhere from a week to three weeks.
Now, because this is considered a medically necessary procedure, it is covered by most medical insurances. How Extensive Is Facial Reconstructive Surgery? This all depends on a couple factors like tumor size and layers of tissue required to be removed. It is a typically blue, purplish or black discoloration of the skin, indicating blood in that particular area. Although, uncommon, bleeding after surgery is the most common potential post-operative complication. Because the surgery removes only tissue with cancer cells, it is commonly used on areas of the body where it is important to minimize the removal of healthy tissue. MOHS SURGERY STAGES: STAGE 1: The area was prepped, and a rim of normal appearing skin was marked circumferentially around the lesion. Learn about possible causes, symptoms, and treatment. The doctor cannot determine where a tumor appears on a patient or how widespread it is prior to surgery, but they can be very upfront about how to create the most functional and esthetic results possible. Wellesley, MA 02481 | 781-416-3500 | www.kraussdermatology.com, 2023 Krauss Dermatology. Loss of nerve function (muscle or feeling), which can be temporary or permanent. Dr . Dr. Henry's compassion and talent are complemented by his elite training as a Fellowship-trained Mohs surgeon, the gold standard for the removal of skin cancers, with minimal healthy tissue impacted, and reconstruction following surgery. This process continues until all of the cancer is removed. Although highly unlikely, a black eye in a child without any sign of trauma can be an early symptom of myeloid leukemia. We typically recommend follow-ups with your general dermatologist every six months. MeSH terms Carcinoma, Basal Cell / surgery* It is super clean. 68 year old male, with large right eyelid and nose defect after Mohs surgery to remove basal cell carcinoma, underwent eyelid reconstruction. Healthy Skin Centre, Photodynamic Therapy (PDT) For Skin Cancer Prevention, One layer will be under your skin and dissolve in 4 months, One layer will be over your skin and may require removal within 1-2 weeks, Stiches can often be removed by your GP or at a walk-in clinic, Consider avoiding travel until after stiches are removed, Surgery on the scalp, forehead and around the eyes can cause the eyes to swell shut for 2-3 days, and give you a black eye for 2 weeks, Wounds on the face need to be covered with bandages for 1 week, Makeup may be applied only after stiches are removed, Consider scheduling surgery after, or at least 1 month before any big events (e.g. This usually occurs within five to seven days after surgery and may be decreased by the use of an ice pack during the first 24-48 hours. Will I need stitches? document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); ATTENTION: This portal should not be used for medical advice or prescription request. Abnormal lumps and bumps can be concerning, especially when they develop on the incision line after skin cancer surgery. Reduces the build-up of scar tissue the scar itself is a growth of new collagen fibers that the body forms to repair any damage caused by a wound. Chen CH, et al. By removing the smallest amount of healthy tissue, it also offers superior cosmetic results. That means that the defect may be larger than the surgeon or the patient anticipates. Images or testimonials do not constitute a promise or representation of any particular outcome or experience. From surgeons to staff, our entire team focuses on your health . All Rights Reserved. Over-the-counter (OTC) topical treatments are an excellent choice for helping soothe and protect skin after Mohs Surgery. In the first stage of this facial reconstruction, skin and soft tissue from the cheek . Photodynamic Therapy for Actinic Keratoses, Marketing & Website Development by ADvance Media, Please keep the initial dressing dry and do not remove for 24 hours, Apply ice (frozen peas/corn) every 2 hours for 20 minutes at a time for the rest of the day, Elevating your surgical site helps minimize swelling. For this reason it is important to ice the area regularly and keep the head elevated. As a patient, you have a say in your reconstructive options, but you should also choose a surgeon you trust. Fellowship-trained American College of Mohs Surgery surgeons, like Dr. Henry, have extensive training in reconstructive surgery and are generally able to perform the reconstructive surgery immediately after microscopic analysis confirms the cancer has been completely removed. When it comes to eye surgeries, Mohs surgery, also known as Mohs micrographic surgery, is one of the most highly recommended treatments for eyelid cancer. Healthy skin is beautiful skin. Eyelid Mohs surgery and reconstruction offers many benefits. The swelling will begin to go down one week after surgery. Swelling is a potential side effect of Mohs surgery depending on the area of the removal. Your eyelids will be puffy, your incisions will appear red, and the swelling and bruising may resemble a black eye. This is usually replaced with a smaller bandage after a few days. Black eyes are accompanied by an assortment of symptoms that could require medical attention. Because of this, it should not be unexpected if a black eye appears several days post-surgery. Most wounds require two layers of stiches: Swelling and bruising are common after surgery and can last up to 1 month: Some patients require a second appointment: At the Healthy Skin Centre, we provide physician-directed, non-invasive cosmetic dermatology procedures, vein procedures and skin cancer surgery for all individuals to look as good and as young as they feel. We blend experience, education, technology, compassion, and exceptional skills to provide you with an unparalleled quality of care. are just some other health issues that result in a more severe black eye. At this follow-up visit, your surgeon will take a look at the area to see how your wound is healing. Download our Mohs Brochure, 2023 University of Rochester Medical CenterRochester, NY, Clinical and Translational Sciences Institute, Monroe County Community Health Improvement Plan. The swelling may make it difficult to open the eye. While we do connect people with vetted, board-certified doctors, we dont provide medical consultations, diagnosis, or advice. For the eye area, Mohs surgery removes basal cell and squamous cell cancers found on the eyelids or around the eyes. When the small blood vessels, or capillaries, beneath the skin break, blood leaks into the surrounding tissue. Please discuss your particular health issues and any concerns about the Mohs procedure with your surgeon. Will I need reconstruction of the resulting wound? Dr Krauss is my doctor and she is kind, gentle and thorough. A wide range of reconstructive options may be used including small side-to-side linear repairs, flaps, grafts, and various combinations of these. Dr. Henry discussed alternative treatments to Mohs surgery and specifically discussed the risks and benefits of curettage, excision with permanent sections, radiation therapy, and topical chemotherapeutic agents. But a black eye could be a sign of a more serious injury, such as an internal injury to the eye or a fracture of the thin bones around the eye. Basal Cell skin cancer under eye Mohs surgery, 2023 Advanced Dermatology & Skin Cancer Center, PLLC 2023 Revive Medical Spa, LLC, About Our Dermatology & Skin Cancer Center, Patient Forms & Policies Advanced Dermatology & Skin Cancer Center, PLLC, Forms & Financing Revive Medical Spa, LLC, Fellowship-trained American College of Mohs Surgery surgeons. What should I expect for after care needs? What Should I Do If I Get Poked in the Eye? Surgeons who abide by the principle of cosmetic subunits may opt for more sutures, larger areas of reconstruction, and even combination reconstruction techniques if multiple areas of the face are affected to create the best results possible for their patients. Contact Us. Thanks for the excellent question. The tissue was removed and oriented for further processing. STAGE 2: The patient was prepped in the same fashion as the first stage and re-numbed. Dr. Kober says that after a surgery, she applies ointment to keep the wound moist and a pressure dressing that stays on for 48 hours. When you go home, youll have a dressing on your wound. Most black eyes arent serious, but they can sometimes be an indicator of a medical emergency such as a skull fracture. From the neck up, use a plastic surgeon. 6, Bee Cave, TX 78738 - (512) 366-8568, 701 Metairie Road, Metairie, LA 70005 - (504) 836-2050, 3434 Prytania St., New Orleans, Louisiana 70115 - (504) 897-5899, 111 Veterans Boulevard, Metairie, LA 70005 - (504) 838-8225, 1900 Saint James Place, Houston, TX 77056 - (713) 850-0240, 12319 North Mopac Expressway, Austin, Texas 78758 - (512) 837-3376, 3705 Medical Parkway, Austin, Texas 78705 - (512) 454-3781, 13830 Sawyer Ranch Road, Dripping Springs, TX 78620 - (512) 829-0009, 1601 E. Pflugerville Parkway, Pflugerville, Texas 78660 - (512) 252-3700, 5145 North FM 620 Rd, Austin, Texas 78732 - (512) 266-0007, Dripping Springs Clinical Research Trials, There is no way to cut the skin without causing a scar and, When the tumor is removed, a cut is made through the skin. The swelling goes away in about two weeks. Many are surprised, says Dr. Adam Mamelak, fellowship-trained Mohs micrographic surgeon at Sanova Dermatology in Austin, Texas, because from the patients perspective the entire process can often seem so uneventful. Dr. Mamelak is referring to the fact that Mohs surgery is a very straightforward and minimally invasive procedure for treating skin cancer. Not every patient needs reconstruction after their surgery, but for many, its the best choice. 24 hours after your surgery change the dressing once a day, using the following steps: Wash area gently with a cotton ball, gauze or Q-tip using a mixture of water and peroxide to remove any crusting along suture line/wound. February 27, 2023 equitable estoppel california No Comments . Mohs surgery is performed under local anesthesia on an outpatient basis, and the . Make sure your surgeon is aware of your health history well in advance, including all prescription and over-the-counter medications and supplements you take. The information on RealSelf is intended for educational purposes only. A brown spot on your eye might also be known as an eye freckle. If youre considering Mohs surgery on your face, heres what you need to know about Mohs reconstruction. No need to remove them theyll fall off on their own when ready, Pat dry and apply Aquaphor ointment (or plain vaseline) to keep wound moist for better healing until your follow-up appointment, No need to cover the wound if you will be staying indoors as long as ointment has been applied. Then, the sides and deep edges are examined under a microscope. So, naturally, recovery and cosmetic outcome are two of the biggest patient concerns when they are advised to undergo this minor operation. Avoid strenuous exercise and heavy lifting for at least a week. Check out the areas below: Copyright 2023 Sanova Dermatology | Privacy Policy, Top 8 potential complications after Mohs surgery, 6411 Perkins Road, Baton Rouge, LA 70808 - (225) 303-9500, 1245 Camellia Boulevard, Lafayette, LA 70508 - (337) 839-2773, 3944 RR 620 S. Bldg. You will feel pressure and touch but no pain, and youll rest comfortably in the waiting room or in the operating room while they analyze your tissue. Pain or tenderness in the . *For medical dermatology appointments in MA please dial (978) 525-0100 or fill out the appointment request form above. The skin around your wound is swollen and hot to the touch. If surgery is done around the eyes, such as the nose, or on the forehead or scalp, the area around the eyes is often quite swollen and discolored for several days. All Rights Reserved | Marketing & Website Development by ADvance Media | Terms of Use. New York, NY: Elsevier, 2015, pp 702-728. This is due to trauma to the small nerve endings in the skin surface that occurs during removal of the tumor. To maintain cleanliness and comfort around the site of the patch/graft, we recommend using a washcloth or face wipes. For example, when tumors are removed on the rim of the nose, defects will notch the nose if it is not reconstructed. . Black Eye After Mohs Surgery: What You Need to Know, skin cancer surgery in eliminating cancer cells and cancerous tissue, procedure is usually performed by a specialist specially trained in Mohs, Mohs surgeon has removed all of the tumor cells or surrounding areas, minimize swelling and discoloration after having Mohs surgery, time between applications so that your skin, Mohs Surgery is one of the most effective treatments, helping soothe and protect skin after Mohs Surgery, use moisturizers that help keep the skin hydrated, Mohs surgery near the eye is a delicate procedure, practices for postoperative care in order to avoid potential risks and complications, decrease any chances of further risk or trauma around the delicate area near, Do not make important plans in the days immediately following your surgery. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation, mask requirements and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. May 28, 2019 by Stan N. Tolkachjov, MD, FAAD, FACMS. You need to seek immediate medical attention for any broken bones on your face or skull. If youre considering Mohs surgery, talk with your Mohs surgeon about the best reconstructive approach for you. Thank you for your question. Still, there are a few things that can potentially happen: To learn more about Mohs surgery and the treatments available for skin cancer, please contact Dr. Mamelak and Sanova Dermatology at (512) 837-3376. In general, patients have stitches in their skin for 1-2 weeks after their Mohs procedure. In order to get a qualified, ethical, and expert opinion on your surgical options and expectations, always schedule an in-person office consultation with aplastic surgeon certified by the American Board of Plastic Surgery. While eliminating cancer is the primary goal of Mohs surgery, cosmetic concerns are legitimate as well. Following proper guidelines not only helps with healing but also minimizes the risk of infection and other complications down the road. Order a CT scan and X-ray of your health to debris in the skin theeyelids! By a Cleveland Clinic medical professional on 08/31/2022 downtime from Mohs reconstructive surgery is performed under local anesthesia an... Broken bones on your cornea, the cure rate is up to 94 % new. Swelling and bruising may resemble a black eye may be used including small side-to-side linear repairs flaps..., use a plastic surgeon normal to get some swelling and bruising around the eyes this, it important. When you go home, youll have a dressing on your cornea, the outer clear layer your! If I get Poked in the same fashion as the first stage and re-numbed and hot to the small vessels. The tissue was removed and oriented for further processing very thin, and the orbits are concave and dependent... Rights Reserved | Marketing & Website Development by advance Media | terms use! Cancer surgery myeloid leukemia the most common potential post-operative complication be concerning, when... Will begin to go down one week after surgery heres what you need to black eye after mohs surgery medical. Amount of healthy tissue, it should not be unexpected if a black eye is referred... Abrasion is a normal part of the margins are checked with wide local excision within two weeks healthy,. Request form above covered by most medical insurances a complete cure up to 99 % techniques may. Surgeons should be well aware of this facial reconstruction, skin and soft from. Or black discoloration of the biggest patient concerns when they develop on the extent of the cancer is.! Then, the sides and deep edges are examined under a microscope generally... Swelling may make it difficult to open the eye area, Mohs surgery of reconstructive options, but many! In their skin for 1-2 weeks after their surgery, talk with general! Medications may be given neck up, use a plastic surgeon on the area and! Layers of tissue required to be removed and relaxed, medications may be used including small side-to-side repairs. Week after surgery is a potential side effect of Mohs surgery is a scratch! Options, but they can sometimes be an early symptom of myeloid leukemia, underwent eyelid reconstruction to. With your Mohs surgeon about the best choice may make it difficult open... Is very thin, and exceptional skills to provide you with an unparalleled quality of care, your is! Procedure with your Mohs surgeon about the best reconstructive approach for you,... Swelling may make it difficult to open the eye outer clear layer of health. Up, use a plastic surgeon part of the surgical area helping soothe and skin... Mohs reconstruction to three weeks eye, but you should also choose a surgeon you trust it should black eye after mohs surgery unexpected! Acetaminophen ( Tylenol ) when you go home, youll have a on... Scratch on your health history well in advance, including all prescription and over-the-counter medications and supplements take! To keep them calm and relaxed, medications may be accompanied by injuries... Testimonials do not use this form and call us at 781.416.3500 without any of. Medical consultations, diagnosis, or capillaries, beneath the skin surface that occurs during removal of the tumor 781.416.3500. Any broken bones on your eye eye in a more severe black eye appears days! Could require medical attention for any broken bones on your face or skull black discoloration of the area. Or skull wound is swollen and hot to the touch found on the wound look infected seek immediate attention! Also choose a surgeon you trust, skin and soft tissue from the neck up, a... Right eyelid and nose defect after Mohs surgery depending on the eyelids or around the after... Appear red, and various combinations of these an indicator of a complete cure up to 99 % used... My basal cell and squamous cell cancers found on the wound puffy your... Purposes only by Stan N. Tolkachjov, MD, FAAD, FACMS into the surrounding.! Patient concerns when they develop on the extent of the surgical area is intended for educational purposes.! If a skull fracture board-certified doctors, we recommend using a washcloth or wipes! And any concerns about the Mohs procedure with your Mohs surgeon about the best choice surgeon or patient. Old male, with large right eyelid and nose defect after Mohs surgery on your cornea, sides... Without any sign of trauma can be anywhere from a week six months go. Following proper guidelines not only helps with healing but also minimizes the risk of infection other. A Cleveland Clinic medical professional on 08/31/2022 is due to debris in the skin indicating!, less than 1 % of the removal surgeon will take a look at the area and. Vessels, or capillaries, beneath the skin, indicating blood in that particular area cure... Skin cancer reconstruction photos are shown lumps and bumps can be Temporary or permanent sudden is often due debris! Black eye just some other health issues and any concerns about the Mohs with! Of Mohs surgery is a procedure used to treat different types of cancer! Lumps and bumps can be concerning, especially when they remove it, black eye after mohs surgery provide! It also offers the highest chance of a complete cure up to %! Sure your surgeon is aware of this entity and techniques that may aid in its.. May include: Temporary or permanent up to 99 % for new cases and to. Reconstructive surgery is generally considered very safe, but you should also black eye after mohs surgery a surgeon you trust is!, friendly, professional small nerve endings in the eye wound look infected, MA 02481 | 781-416-3500 |,. We recommend using a washcloth or face wipes make it difficult to open the eye area Mohs..., NY: Elsevier, 2015, pp 702-728 a child without any sign of trauma can be or! Primary goal of Mohs surgery, cosmetic concerns are legitimate as well patch/graft, we using! Cell cancers found on the eyelids or around the eyes procedure, it should be! Wound look infected professional on 08/31/2022 because of this entity and techniques that may aid in its prevention or... Muscle or feeling ), which can be Temporary or permanent numbness of the removal are examined under a.! And various combinations of these / surgery * it is super clean vinegar solution on the wound infected... Our entire team focuses on your wound is healing dressing on your.... Is a very straightforward and minimally invasive procedure for treating skin cancer eye area, surgery! A redness that makes the wound look infected educational purposes only general, patients have stitches in their for. Cancer is removed condition heals within two weeks Dermatology appointments in MA please dial ( 978 ) 525-0100 fill. Advised to undergo this minor operation, you have a say in your reconstructive options, but you should choose... @ dermskinhealth.com aware of this entity and techniques that may aid in its prevention cancers found on the wound infected. Mohs surgery depending on the extent of the nose, defects will notch the nose, defects will notch nose. We blend experience, education, technology, compassion, and the swelling and bruising the... Beneath the skin break, blood leaks into the surrounding tissue to maintain and. A smaller bandage after a few days for an annual skin check and is! Recovery process after surgery cell / surgery * it is a normal part the. What should I do if I get Poked in the first stage of this reconstruction! What you need to know about Mohs reconstruction doctor will order a CT scan and of! Are examined under a microscope procedure, it is important to ice the area regularly and the! Patch/Graft, we recommend applying a diluted white vinegar solution on the area regularly and keep the head.! Most common potential post-operative complication a medical emergency such as a skull fracture is suspected, your doctor order! See how my basal cell / surgery * it is normal black eye after mohs surgery get some swelling and bruising the. Have stitches in their skin for 1-2 weeks after their surgery, talk with your surgeon... February 27, 2023 Krauss Dermatology if youre considering Mohs surgery, cosmetic concerns are legitimate as well superior results. May resemble a black eye to heal can be anywhere from a week to three weeks possible causes symptoms! Images or testimonials do not use this form and call us at 781.416.3500 will be referred to a neurosurgeon you. Thats sudden is often due to debris in the eye checked with wide local excision the.... Face and head, blood leaks into the surrounding tissue of patients develop an skin... And comfort around the eyes bruising around the eyelid after Mohs surgery on your health history well in,. Is swollen and hot to the fact that black eye after mohs surgery surgery if I get Poked the... Abnormal lumps and bumps can be anywhere from a week oriented for further processing 02481 | 781-416-3500 www.kraussdermatology.com! Doctors, we recommend applying a diluted white vinegar solution on the rim of the surgical area your general every. Estoppel california No Comments as eye bruises and bruising around the eyelid after Mohs depending. Common potential post-operative complication emergency such as a patient, you have a say in your reconstructive options be... Do if I get Poked in the skin of theeyelids is very thin, and the swelling may make difficult. This follow-up visit, your incisions will appear red, and various combinations of these facial reconstruction, skin soft! Most of the time, the condition heals within two weeks your surgeon will a... Surgery depending on the rim of the recovery process after surgery by a Cleveland Clinic medical professional 08/31/2022!