Dermatologic Surgery

Dermatologic Surgery/ Dermasurgery

Dermasurgery deals with the diagnosis and treatment of medically necessary and cosmetic conditions of the skin, hair, nails, veins, mucous membranes and adjacent tissues by various surgical, reconstructive, cosmetic and non-surgical methods. The purpose of dermasurgery is to repair and/or improve the function and cosmetic appearance of skin tissue.

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Examples of dermasurgery procedures include anti-aging treatments, injectable and implantable soft tissue fillers, botulinum toxin treatments, correction of acne scarring, chemical peeling, tumescent liposuction, vein therapy, hair restoration, laser surgery, removal of cysts, moles, and lipomas, skin cancer treatment, and reconstructive flaps and grafts.

All of the procedures are performed at our AAAHC accredited Office Based Surgery Center.

Skin Cancer

Skin cancer refers to the abnormal, uncontrolled growth of skin cells. One in five people will develop skin cancer in their lifetime, according to the American Academy of Dermatology. Risk factors include pale skin, family history of melanoma, being over 40 years old, and regular sun exposure. Fortunately, skin cancer is almost always curable if detected and treated early.
The most common skin cancers are:

  • Basal cell carcinoma
  • Squamous cell carcinoma
  • Melanoma

Mohs Micrographic Surgery

Mohs surgery involves the systematic removal and analysis of thin layers of skin at the tumor site until the last traces of cancerous tissue have been eliminated. The immediate and complete microscopic examination and evaluation of excised tissue is what differentiates Mohs surgery from other cancer removal procedures. Mohs surgery has been shown to be a highly effective treatment for certain types of skin cancer, with a cure rate of up to 99% for certain tumors. Due to the fact that the Mohs procedure is micrographically controlled, it provides the most precise method for removal of the cancerous tissue, while sparing the greatest amount of healthy tissue. For this reason, Mohs surgery may result in a significantly smaller surgical defect and less noticeable scarring, as compared to other methods of skin cancer treatment. The Mohs procedure is recommended for skin cancer removal in anatomic areas where maximum preservation of healthy tissue is desirable for cosmetic and functional purposes. It may also be indicated for lesions that have recurred following prior treatment, or for lesions, which have the greatest likelihood of recurrence.

Dr. Alaiti has performed several hundreds of Mohs surgeries over his career. Mohs surgery is performed under local anesthesia as an outpatient procedure at our office based surgery center. Dr. Alaiti is a member of the American Society of Mohs Surgery.

Total Body Exam

Coupled with a yearly skin exam by a doctor, self-examination of your skin once a month is the best way to detect the early warning signs of basal cell carcinoma, squamous cell carcinoma, and malignant melanoma, the three main types of skin cancer. Look for a new growth or any skin change.

When a melanoma is detected at an early stage and treated, it is usually curable. Some melanomas are hidden in everyday life - by inconspicuous locations on the body; by clothing; even by hair on our heads. But many, if not most, melanomas can be spotted as soon as they arise - if you know what to look for and check for those signs.

The ABCDE's of Moles & Melanoma

Most people have a number of brownish spots on their skin - freckles, birthmarks, and moles. Almost all such spots are normal, but some may be skin cancers. Key warning signs of melanoma are shown below. Be alert to irregularities in shape, edges, color, and size. The ABCD's of melanoma are as follows: Asymmetry, Border irregularity, Color variability, and Diameter larger than a pencil eraser, and Evolution.

  • Asymmetry: Most early melanomas are asymmetrical: a line through the middle would not create matching halves. Common moles are round and symmetrical.
  • Border: The borders of early melanomas are often uneven and may have scalloped or notched edges. Common moles have smoother, more even borders.
  • Color: Common moles usually are a single shade of brown. Varied shades of brown, tan, or black are often the first sign of melanoma. As melanomas progress, the colors red, white and blue may appear.
  • Diameter: Early melanomas tend to grow larger than common moles - generally to at least the size of a pencil eraser (about 6mm, or 1/4 inch, in diameter).
  • Evolution:  If there is a change in the appearance, sensation, size, color, shape of a mole, a sudden elevation of a mole, bleeding, or a change in the surface of a mole or the surrounding skin, this may be a warning sign.

Scar Revision

Scar revision is performed to reduce the appearance of scars caused by injury or previous surgery. Scars are by definition permanent, but surgery can narrow, fade and otherwise reduce the appearance of severe or unattractive scarring, which is especially helpful in areas of cosmetic importance such as the face and hands.

Revision of Acne Scars

Ice-pick (narrow and deep), and box-car (wide and deep) acne scars can be removed by surgical excision. This technique may entail punch excision of a given small acne scar with a punch biopsy instrument of equal or slightly greater diameter. Then one or two 5.0 or 6.0 simple interrupted sutures are used to close the resulting defect, with the attendant transformation of a round, indented scar into a flat slit-like scar. Larger linear box-car scars can be excised by elliptical excision and repaired by bilayered closure.

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Alternatively, after punch excision of a small scar, the defect may be filled by a punch graft. Harvested from another area, commonly the postauricular sulcus, a punch graft is pressed into the created defect and either sutured or glued in place.

Subcision is a surgical intervention that may be useful for a subset of scars.  It is best for "rolling scars", which resemble broad-based, gently undulating hills and valleys rather than craters with steep edges.  These scars may be made less noticeable after being subcised.  Subcision is a method for subdermal undermining of depressed area. The procedure involves inserting a hypodermic needle just under the dermis to release the fibrous attachments tethering the epidermis and dermis to the subcutis.  Minimal post-operative bruising culminates in speedy recovery.  Patches of rolling scars may be less evident after treatment.  Residual scars may be more amenable to further reduction by modalities such as chemical peeling or laser resurfacing.  The procedure is done under local anesthesia.

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