Dermabrasion, laser resurfacing and ablation
Minor skin surgery
Limited cuts are made in the skin either for operations such as skin cancer removal, scar revision or to remove lumps from beneath the skin such as a sebaceous cyst or lipomas. The incisions are usually a little longer than any underlying lump to allow its complete removal. Flap surgery where adjacent skin is used to reconstruct or close the resulting defect may be used. Stitches will be required.
Skin lesions such as moles or skin tumours which require biopsy (see below) are removed with a margin of 3-5mm to ensure complete removal. It is usual to cut out the area as an ellipse which ensures a smooth flat scar after the stitches have been inserted in the scar. Flap surgery where adjacent skin is used to reconstruct or close the resulting defect may be used. The scar will, however, be 3-4 times the length of the original skin lesion. In some areas such as the back and shoulder where poor quality scars are common (see below), I prefer to remove skin lesions as a circle and then allow them to heal without stitches.
Some lesions which are considered to be benign are suitable to be shaved off, the base being cauterised (electrical sealing). No stitches are used.
The removal of tissue for examination under a microscope by a Pathologist. Results become available in several days. Tissue for examination can be obtained by any of the techniques mentioned above. The most common technique however to biopsy a skin lesion is a punch biopsy. Under local anaesthetic, a small (usually 2mm) disk of tissue is taken for examination. The resulting small wound usually does not even require a stitch and heals without a noticeable scar quickly.
Many wounds in exposed areas such as the face will be left uncovered after the operation. Antiobiotic ointment applied to the stitches twice a day is usually prescribed. A plaster will be applied to other areas to avoid rubbing but this can be removed after 48 hours. At this stage most wounds are watertight and can become wet in the bath or shower. Plasters do not protect against infection and fresh air and water is healthier than a dirty, sweaty plaster covered wound line. Antibiotic ointment will be prescribed to put on the stitches daily. Please do not apply antiseptics such as Dettol or Savlon to the wound.
Natural oil production in the skin is disturbed by surgery and the skin around wounds often becomes dry and flakes. After 48 hours, it is helpful to apply small amounts of moisturising cream, particularly after bathing.
Any operation, no matter how small, can be complicated by infection, bleeding or stitch lines separating. These are, however, uncommon following simple skin surgery.
All operations leave a scar but over time these fade and become very acceptable. The type of scar is dependent on age, race and site of surgery. If you have scarred poorly from previous surgery this may indicate that you form poor scars.
Scars are often lumpy and red when immature and may look worse at about three months after surgery. This is a reflection of normal healing. Maturation takes 12-24 months depending on age and skin type and during this time the pinkness and firmness of the scar gradually settles. This process can be helped by massaging the wound firmly with a moisturising cream.
Some areas are more prone to form poor scars such as the front of the chest, shoulder and earlobes. Wounds under tension such as on the back or over joints can stretch in the months after the stitches have been removed.
Areas with a good blood supply such as the face heal quickly whereas others such as the leg heal more slowly. The timing of stitch removal therefore varies being 5-7 days on the face and 14-21 days on the body. You will be asked to keep stitches dry for 48 to 72 hours after the operation.
The anaesthetics used for minor skin surgery usually wears off after 2 to 4 hours. Some discomfort may be experienced following this over 48 hours or so when swelling is maximal. This pain or throbbing is, however, mild to moderate and can be controlled with simple analgesics such as panadol or panadiene. If more severe pain is anticipated, you may be prescribed something stronger. Resting and avoiding activity for the week following surgery is the best way to minimise discomfort that may be experienced.