Dermatosurgery

Sagging or splitting of ear piercing hole is commonly seen among women .This may happen due to use of heavy ear rings, any trauma or as a part of ageing itself.

The split may be partial or complete and can be seen in both ear lobules or only one, depending upon the cause .

Repair of split or sagged ear lobe can be done by a minor procedure called Lobuloplasty. This is a simple and easy correction procedure done under local anaesthesia with a very short healing time and effective results.

Ear piercing can be done again after complete healing.

Nail surgeries are routinely performed by dermatologists for various indications.

Among them nail avulsion/removal is most commonly done . Partial ( a part of nail ) or total nail avulsion can be performed depending on the cause.

Nail avulsion is done for Onychomycosis ( fungal infection of nail ), ingrown nail
(causing symptoms of pain and recurrent infection),to treat warts ( viral infection ) which tend to grow under the nail plate and tumours growing under the nail plate.

Some dermatological diseases affecting nail and nail bed will require a biopsy to establish an accurate diagnosis. Nail plate and nail bed biopsy is done whenever deemed necessary.

Nail surgeries can be done on both finger and toe nails.

Keloid form due to excess formation of scar tissue. They occur following any trauma or in surgical scars. Genetic predisposition to development of keloid is known.

Keloids look cosmetically displeasing. Some complain of pain and itching in keloid. The appearance is distressing for most when keloids are on exposed areas/ visible areas of the body.

Ears, shoulders, front of chest and back are the common sites where keloids occur.

Keloids of ear lobes are best treated surgically. Flap surgeries which give the best results are done by dermatologists.

Keloids have a tendency to recur. Discuss with your dermatologist about the amenability of your keloid to surgery .

Vitiligo is an autoimmune disease which leads to formation of white patches on the body due to destruction of melanocytes (pigment forming cells).

Medical treatment is the first option for treating the patches. Either topical medication or oral or both are given.

Vitiligo patches/lesions on fingers and toes, on bony prominences, lips, areola, genitalia, segemental type of vitiligo and in patches where the hair turns white (leucotrichia ) usually do not respond well to medical therapy. For such vitiligo patches surgical treatment offers good results .

Surgery is taken up only in cases where the vitiligo patches have been stable without any change.

Different surgical procedures such as suction blister grafting, punch grafting, split skin thickness grafting, cultured and non cultured autologous melanocyte cell suspension are done depending upon the site and size of the vitiligo patch.

Cysts are soft to firm lumps or bumps seen on skin .

Sebaceous cysts are commonly encountered on face, neck and trunk and are slow growing lesions. Sebaceous cysts have a small opening on the surface which is called a punctum and upon applying pressure over the cyst there is foul smelling fluid discharge noted, oozing from the punctum.

Sebaceous cysts are harmless. They rarely get infected and inflamed leading to discomfort .

These cysts can be excised either due to their unsightly appearance or when they cause discomfort because of recurrent infection or inflammation. It is important to completely remove the sac of the cyst to prevent recurrence.

Keratinous cysts, Trichilemmal cysts and various benign tumours occurring on skin can also be treated by excision under local anesthesia .

Moles or Naevi are present at birth(hence known as birthmarks) or appear later in life.

They can be

-Congenital melanocytic naevi which are always present at birth and are usually larger and more deeper in colour than other naevi.

– Acquired melanocytic naevi which are seen in early childhood. They can be seen as flat pigmented lesions, as slightly raised ones with darker centre and can also present as dome shaped nodules with smooth surface.

– Dysplastic naevi are larger in size with irregular outlines and these carry a risk of turning malignant.

Moles usually do not pose any risks but few may show changes indicating malignant transformation.

Mole excision is done for both aesthetic and medical reasons.

Consult your dermatologist to get your moles checked in case of any physical changes seen in the mole .

Moles can be excised surgically under local anaesthesia .This will leave a small acceptable scar. Ideally all the excised moles are sent for histopathological examination.

Flat moles can also be targeted with lasers (Q switched ND:YAG ). There is a chance of recurrence of mole following this procedure.

Lipomas are lumps of fat which can appear anywhere in the skin, especially in genetically predisposed individuals. They do not pose any risk, however can be disfiguring cosmetically.

Although traditionally they were removed by surgical excision, it would lead to bigger scarring. Lipomas which are freely mobile and located in certain specific locations can now be removed through a simple punch hole excision, where in the risk of scarring is least and results are excellent.

Trauma to skin in most cases leads to scarring .The trauma may be due to any physical, chemical or pathological (disease ) cause. Scar is rather inevitable following deeper skin injuries.

Scars can be raised above the surface of skin or may be seen as depressed  ones.

These unsightly scars can be made less prominent and more cosmetically acceptable by scar revision surgery. Various methods such as simple excision, resuturing along the lines of contour, z-plasty etc help to bring good cosmetic results.