Definition (What it is) of dermatologic surgery
Dermatologic surgery is a group of medical and cosmetic procedures performed on the skin, hair, nails, and underlying soft tissue.
It includes both surgical and minimally invasive techniques to diagnose, remove, repair, or improve skin lesions and surface irregularities.
It is commonly used for reconstructive care (such as skin cancer removal and repair) and cosmetic care (such as scar revision or resurfacing).
The exact methods used vary by clinician and case.
Why dermatologic surgery used (Purpose / benefits)
Dermatologic surgery is used when a skin concern is best addressed by physically removing, reshaping, repairing, or resurfacing tissue rather than relying on topical or oral treatments alone. In reconstructive settings, the goal is often to treat disease (for example, removing a suspicious or cancerous lesion) while preserving function and achieving a cosmetically acceptable repair. In cosmetic settings, the focus is commonly on improving visible features such as texture, uneven pigmentation, scars, laxity, or unwanted growths.
Potential benefits, depending on the indication, can include:
- Diagnosis and definitive treatment in the same care pathway (for example, biopsy followed by removal and repair when appropriate).
- Targeted removal of localized lesions with attention to margins and tissue preservation.
- Functional restoration in areas where skin changes affect comfort, movement, or eyelid/nasal/lip function.
- Cosmetic refinement of scars, contours, or surface irregularities using precise, tissue-sparing techniques.
- Customized repair options (such as layered closure, flaps, or grafts) chosen to match the anatomic site and skin characteristics.
Outcomes depend on the condition being treated, skin type, location, healing response, and the clinician’s technique.
Indications (When clinicians use it)
Common reasons clinicians use dermatologic surgery include:
- Biopsy of a suspicious lesion to establish a diagnosis
- Excision of benign lesions (for example, certain cysts or lipomas) when symptomatic or cosmetically unwanted
- Removal of skin cancers (for example, basal cell carcinoma or squamous cell carcinoma) and subsequent repair
- Mohs micrographic surgery for select skin cancers where tissue conservation and margin control are important
- Repair after lesion removal using layered closure, flaps, or grafts
- Scar revision for selected scars that are raised, widened, tethered, or poorly oriented relative to skin tension lines
- Nail procedures (such as management of ingrown nails) in appropriate cases
- Treatment of selected vascular or pigmented lesions using laser or other energy-based modalities when indicated
- Cosmetic procedures such as resurfacing or limited tightening in carefully selected candidates (varies by clinician and case)
Contraindications / when it’s NOT ideal
Dermatologic surgery may be delayed, modified, or avoided in situations such as:
- Active infection at or near the treatment site
- Poorly controlled medical conditions that increase procedural risk (varies by clinician and case)
- Medications or bleeding tendencies that raise the risk of bruising or bleeding; management varies by clinician and case
- History of problematic scarring (for example, keloids) where the risk–benefit balance is unfavorable for elective procedures
- Unclear diagnosis when additional evaluation is needed before definitive treatment
- Lesions in locations where another specialty approach is preferred (for example, complex functional reconstruction), depending on clinician expertise and resources
- Patient factors that limit safe positioning, wound care, or follow-up (for example, inability to return for suture removal when needed)
- Cosmetic goals that are better matched to non-surgical options (for example, certain pigment concerns that respond to topical regimens) or to a different surgical plan
Appropriateness depends on anatomy, diagnosis, and the proposed technique.
How dermatologic surgery works (Technique / mechanism)
Dermatologic surgery spans surgical, minimally invasive, and energy-based approaches. The choice of method depends on the problem being treated and the depth and location of the target tissue.
At a high level, dermatologic surgery works by one or more of the following mechanisms:
- Remove: Cutting out a lesion (excision), shaving/paring superficial growths, curettage (scraping) with or without electrosurgery, or staged removal with margin assessment (such as Mohs surgery for appropriate skin cancers).
- Reshape / reposition: Closing a wound in layers, adjusting tension lines, or using local flaps (moving nearby skin) to optimize contour and scar placement.
- Restore surface or texture: Resurfacing with lasers, dermabrasion, or chemical methods (used in selected settings) to address irregular texture or certain scars; the closest relevant mechanism is controlled injury to stimulate remodeling.
- Destroy targeted tissue without traditional cutting in some cases: Cryosurgery (freezing) or electrosurgery may be used for selected benign or precancerous lesions, depending on diagnosis and location.
- Reconstruct: Using skin grafts (transplanting skin from another site) or complex closures when necessary after removal of a lesion.
Typical tools and modalities include:
- Local anesthetic injections; sometimes oral anxiolysis or procedural sedation (varies by setting and case)
- Scalpel excision and specialized blades for shave procedures
- Curettes, electrosurgical units, and hemostatic agents for bleeding control
- Sutures (absorbable and non-absorbable) and adhesive strips/tissue adhesives for closure support
- Lasers or other energy-based devices for selected resurfacing or lesion-targeting applications
Implants are generally not a core feature of dermatologic surgery in the way they are in many plastic surgery procedures. When volume restoration is needed in cosmetic contexts, clinicians may consider injectables, but this varies by clinician and case.
dermatologic surgery Procedure overview (How it’s performed)
While exact steps differ by procedure type, a typical workflow looks like this:
- Consultation: Discussion of the concern, medical history, medications, prior scarring, and goals (medical and/or cosmetic).
- Assessment / planning: Examination of the site, decision on technique, and review of expected trade-offs such as scar location, downtime, and follow-up needs. Photos and measurements may be used for documentation.
- Prep / anesthesia: Skin cleansing and sterile preparation are performed. Local anesthesia is common; sedation or general anesthesia may be used for select cases depending on extent, location, and setting.
- Procedure: The lesion is biopsied, removed, resurfaced, or repaired using the planned approach. If tissue is removed, it may be sent for pathology when appropriate.
- Closure / dressing: The site may be closed with layered sutures, allowed to heal by secondary intention in selected cases, or repaired with a flap or graft. A dressing is applied and wound-care instructions are reviewed.
- Recovery / follow-up: Follow-up may include dressing changes, suture removal when needed, pathology review, scar management planning, and monitoring for recurrence where relevant.
Specific timelines and steps vary by clinician and case.
Types / variations
Dermatologic surgery includes several categories, often grouped by whether they involve cutting, energy-based treatment, or injectables.
Surgical (incisional) procedures
- Biopsy: Shave, punch, or excisional biopsy depending on the suspected diagnosis and depth of concern.
- Excision: Elliptical or tailored removal of a lesion with closure; used for many benign and malignant lesions.
- Mohs micrographic surgery: Staged removal with immediate microscopic margin evaluation for selected skin cancers; commonly used where tissue conservation is important.
- Repair and reconstruction:
- Primary closure (bringing edges together)
- Layered closure (deep and superficial sutures to manage tension)
- Local flaps (advancement, rotation, transposition patterns)
- Skin grafts (full-thickness or split-thickness depending on indication and surgeon preference)
Minimally invasive lesion treatments
- Cryosurgery: Controlled freezing for selected lesions (often superficial), depending on diagnosis and site.
- Curettage with electrosurgery: Scraping followed by electrosurgical treatment in selected cases.
Energy-based and resurfacing approaches (selected cosmetic and medical uses)
- Laser procedures: Vascular lasers, pigment-targeting lasers, and ablative or non-ablative resurfacing lasers are used based on the target (blood vessels, pigment, texture).
- Other resurfacing methods: Dermabrasion or chemical resurfacing may be used in selected cases (technique availability varies by clinician and case).
Anesthesia choices (when relevant)
- Local anesthesia is common for many dermatologic surgeries.
- Local anesthesia with oral medication may be used for anxiety or comfort in selected patients (varies by clinician and case).
- Procedural sedation or general anesthesia may be considered for extensive repairs, pediatric cases, or complex locations, depending on facility resources and clinician preference.
Pros and cons of dermatologic surgery
Pros:
- Can provide a definitive approach for many localized skin lesions
- Often allows precise treatment tailored to the diagnosis and anatomic site
- Can combine removal and reconstruction in the same treatment plan
- Offers multiple repair options to manage scar placement and contour
- Includes both medical and cosmetic applications within one specialty framework
- Pathology evaluation may be incorporated when tissue is removed, when appropriate
Cons:
- Scarring is possible with any procedure that disrupts skin; scar quality varies by individual and location
- Risks such as bleeding, infection, delayed healing, or pigment change can occur (risk level varies by clinician and case)
- Some procedures require follow-up visits for wound checks, dressing changes, or suture removal
- Cosmetic outcomes can be less predictable in high-tension areas or in patients prone to hypertrophic scars or keloids
- Energy-based treatments may require multiple sessions and can have downtime depending on intensity and skin type
- Recurrence of certain lesions is possible even after treatment, depending on diagnosis and margins
Aftercare & longevity
Aftercare and durability in dermatologic surgery depend heavily on the specific procedure, the anatomic site, and the reason the procedure was performed.
General factors that influence healing quality and how long results last include:
- Technique and closure design: Tension management, layered closure, and reconstruction choice can affect scar width and contour over time.
- Skin quality and biology: Age, baseline elasticity, pigmentation tendencies, and personal scarring history influence visible healing.
- Location on the body: Areas with more movement or tension (or thicker/sebaceous skin) may heal differently than low-tension areas.
- Sun exposure: UV exposure can affect pigment changes and how noticeable scars or discoloration become over time.
- Smoking and vascular health: Factors that reduce oxygen delivery can affect healing and the appearance of scars (impact varies by individual).
- Consistency of follow-up: Some procedures require planned visits to monitor healing, review pathology, and guide scar maturation.
- Maintenance for cosmetic concerns: For texture, pigment, or vascular concerns treated with energy-based devices, long-term appearance may depend on ongoing skincare, sun protection habits, and periodic maintenance chosen with a clinician.
“Longevity” means different things depending on the indication. Removing a benign lesion or cancer is different from resurfacing for texture; durability and maintenance needs vary by clinician and case.
Alternatives / comparisons
Alternatives depend on whether the goal is medical (diagnosis/treatment) or cosmetic (appearance), and whether the concern is superficial or deep.
- Observation / monitoring: Some benign lesions can be monitored rather than removed, depending on clinical assessment and patient preference. This is not appropriate for lesions with concerning features.
- Medical (non-surgical) therapy: Topical or oral treatments may be used for inflammatory skin diseases or certain superficial lesions, but they may not replace the need for biopsy or removal when diagnosis is uncertain.
- Non-surgical cosmetic options:
- Injectables (neuromodulators and fillers) can address wrinkles or volume changes without removing tissue, but they do not replace lesion excision or cancer treatment.
- Energy-based devices (lasers, light-based treatments, radiofrequency, ultrasound) may improve texture, redness, or laxity in selected patients, often with different downtime and repeat-session patterns than surgery.
- Plastic surgery or ENT/oculoplastics approaches: For complex facial reconstruction, functional eyelid or nasal repairs, or combined deep-tissue procedures, another surgical specialty may be involved. The best setting depends on the defect, goals, and clinician expertise.
- Radiation therapy: Sometimes used for certain skin cancers when surgery is not feasible, but it has different indications, side-effect profiles, and follow-up considerations.
Comparisons are rarely one-size-fits-all. The “right” approach depends on diagnosis, anatomic constraints, patient priorities, and available expertise.
Common questions (FAQ) of dermatologic surgery
Q: Is dermatologic surgery painful?
Most procedures use local anesthesia to reduce pain during treatment. Patients may still feel pressure, movement, or brief stinging with anesthetic injection. After the procedure, soreness varies by procedure type, location, and individual sensitivity.
Q: Will I have a scar?
Any procedure that cuts or removes skin can leave a scar. Clinicians often plan incisions and closures to place scars in less noticeable lines when feasible, but scar appearance depends on location, tension, skin type, and personal healing tendencies. Some procedures that do not involve cutting (like certain laser treatments) can still cause temporary or, less commonly, persistent pigment or texture changes.
Q: What kind of anesthesia is used?
Local anesthesia is common for many dermatologic surgeries. Sedation or general anesthesia may be used for extensive repairs, sensitive locations, or specific patient needs, depending on the facility and clinician. The anesthesia plan is individualized.
Q: How long is the downtime?
Downtime varies widely. A small biopsy may have minimal disruption, while larger excisions, flaps, grafts, or ablative resurfacing may require more time for wound care and visible healing. Social downtime (visible redness, swelling, or dressings) can differ from physical downtime (activity limitations), and both vary by clinician and case.
Q: How long do results last?
If a lesion is completely removed, the change can be long-lasting, although some conditions can recur. For cosmetic resurfacing or redness/pigment treatments, maintenance may be needed over time because skin continues to age and environmental exposures continue. Longevity varies by clinician and case.
Q: Is dermatologic surgery safe?
Dermatologic surgery is widely performed in outpatient settings, but “safe” depends on the specific procedure, patient health factors, anatomic site, and clinician experience. All procedures have potential risks, including bleeding, infection, delayed healing, pigment change, and unsatisfactory cosmetic outcome. Risk discussions are typically part of informed consent.
Q: How much does dermatologic surgery cost?
Costs vary based on the diagnosis, size and location of the lesion, whether pathology is needed, the type of repair (simple closure vs flap/graft), anesthesia setting, and geographic region. Cosmetic procedures are often self-pay, while medically necessary procedures may be covered by insurance depending on the plan and documentation. Exact pricing varies by clinician and case.
Q: What happens to the tissue that is removed?
Removed tissue is often sent to a pathology lab when diagnosis confirmation or margin assessment is needed. For certain benign-appearing lesions, clinicians may or may not send tissue depending on clinical judgment, documentation requirements, and patient preference. This varies by clinician and case.
Q: What’s the difference between excision and Mohs surgery?
Excision typically removes the lesion with a planned margin and then closes the wound, with pathology processed afterward. Mohs micrographic surgery is a staged technique where tissue is removed and examined in near real time to assess margins, repeating stages until clear margins are achieved. Which method is appropriate depends on the type of lesion, location, recurrence risk, and clinician recommendation.
Q: Who performs dermatologic surgery?
Many procedures are performed by dermatologists with surgical training; some are performed by dermatologic surgeons with additional fellowship training, and some by plastic surgeons or other specialists depending on the case. The best fit depends on the diagnosis, complexity of reconstruction, and the clinician’s specific experience with the planned technique.