Skin Surgery

Skin Surgery

MOLE REMOVAL

Overview
Moles are extremely common and come in various colors, sizes, and appearances: pink, brown, flat, or raised. The foremost priority is to ensure that moles or skin lesions are benign by having them checked by Dr. Alan Rockoff. Fortunately, most moles are harmless and do not need to be treated. Some moles, however, can be unsightly and distracting.  In these situations, mole removal may provide improved appearance, confidence, and well-being.

Am I a good candidate for mole removal?
You are a good candidate for mole removal if you have:

  • a benign mole that has been evaluated by Dr Alan Rockoff
  • a mole which bothers you and detracts from your appearance

What happens during the initial consultation for mole removal?
During the consultation, Dr. Chung will:

  • evaluate the size, color, and appearance of the mole
  • assess your skin type and discuss options for removal, including surgical excision, shaving, or scraping
  • carefully assess the location of the mole and its close proximity to importance facial structures such as your nostrils, lips, and eyes

Some plastic surgeons may not view a mole removal with the same gravity as a face lift, but Dr. Chung approaches each patient and procedure with the same discerning ear, artistic eye, and attention to detail. This is your face, and Dr. Chung is dedicated to providing you with the highest quality results with the most minimal scars.

What happens during the mole removal?
In the office, the mole is injected with local anesthetic to numb the area. Various treatment modalities may be used.

  • surgical excision will completely remove the mole requires placing tiny stitches to repair the area from which the mole was excised
  • shaving will remove the raised part of the mole
  • electrodessication will burn off small, raised moles
  • scraping will remove some of the superficial layers of the mole

What is the recovery like?
There is very little downtime associated with a mole removal. Most patients return to work the next day. If there are stitches, they are usually removed in 5-7 days. With certain procedures, such as elecrodessication and shaving, a small scab may form on the mole which falls off after a few days.

What will I look like?
There is always a faint scar associated with a mole removal. With surgical excision, the scar may be a faint, thin line which improves over time. Patients who are bothered by the appearance of their moles find that a faint scar is a worthwhile trade-off for a cosmetically unappealing mole.

SKIN CANCER SURGERY

Overview
Skin cancer is the most common type of cancer worldwide. It may affect people of all races and colors, although patients with lighter skin are at highest risk. Other risk factors include a personal history of sunburns, the use of tanning beds, immunosuppression, and a family history of skin cancers.
The most common types of skin cancers are:

  • basal cell carcinoma
  • squamous cell carcinoma
  • melanoma

Several treatment options are available for skin cancer and depend on type, location, and size. Complete removal of skin cancer may leave a sizable defect that requires reconstructive surgery to obtain favorable functional and cosmetic outcomes. Dr. Chung has significant expertise in skin cancer excision and reconstruction, having served as the Chief of Facial Plastic and Reconstructive Surgery at the Stratton Veteran’s Hospital in Albany, New York and collaborated with her many dermatology colleagues. Dr. Chung has removed and reconstructed several thousand skin cancers defects.

What happens during the initial consultation for a skin cancer?
During the initial consultation, Dr. Chung will review the size, location, and type of your skin cancer.  For certain basal and squamous cell carcinomas, she may recommend surgical reconstruction after Mohs excision is performed by one of her dermatology colleagues. Mohs surgery is a procedure that removes skin cancer using a microscope to define which tissue needs to be removed for a safe and precise excision. Dr. Chung works closely with many Mohs surgeons in a team-based approach. Dr. Chung will then discuss the possible reconstructive options, reviewing the placement of scars and discussing likely outcomes. Her office will then make arrangements for the cancer excision and reconstruction. The procedure is usually performed in the office but in some instances, depending on the complexity of the reconstruction, Dr. Chung may recommend that you have your surgery in the hospital.

What happens during the skin cancer surgery?
During the procedure, Dr. Chung will mark out the skin cancer, taking into account the appropriate margins as well as the important adjacent structures of the face. The procedure is usually performed in the office under local anesthesia. If Dr. Chung is removing the skin cancer, she will send the lesion to a pathology lab for full diagnostic evaluation; otherwise, you will have the skin cancer removed by a Mohs surgeon. Using advanced reconstructive techniques, Dr. Chung will then rearrange the skin to close the defect, optimizing the cosmetic outcomes. Tiny stitches and a bandage will then be placed.

What is the recovery like?
Immediately after surgery, there may be some mild swelling, bruising, and mild discomfort. You will need to keep the incision covered and dry for a few days. After 2-3 days, you can usually remove the bandages and take a shower. The stitches are removed in 5-7 days.

What will I look like?
The incision may be slightly pink for a few weeks, but there will be continued improvement for several months. In efforts to minimize visible scars and avoid other troubling lesions, Dr. Chung will direct you on proper wound care with scar creams and sun protection; she will also encourage you to keep up with your routine skin checks with your dermatologist.

UPPER EYELID BLEPHAROPLASTY

Overview
The upper eyelids are one of the first areas of your face to show signs of aging. As the eyelids droop and sag, you may appear older and more tired than you actually are. This loose, sagging skin may also allow fat pockets around the eye to protrude, causing your eyes to appear puffy. In upper blepharoplasty, also known as upper eyelid surgery, excess skin and fat are removed from your eyes to create a natural, more awake, more vibrant appearance without changing the shape of the eyes.

It has been said that the eyes are the windows to our souls.  Our eyes are the defining features of our face and shape our interactions with others.  For these reasons, blepharoplasty is an extremely popular procedure. With the advanced techniques used by Dr. Chung, your blepharoplasty may be safely and effectively performed in the office under local anesthesia, with the expectation that you would be able to return to work within a week. Dr. Chung has performed countless eyelid procedures on her patients from the Boston area, including Brooklime, Wellesley, Newton, Needham, Andover, North Andover, Waltham, Salem, Peabody, Lynnfield, and the surrounding communities.

Am I a good candidate for blepharoplasty?
If you have excess upper eyelid skin or puffy bags around the eyes, you may be an excellent candidate for blepharoplasty. The best candidates for this procedure are healthy patients who do not smoke and do not have any serious eye conditions.

What happens during the initial consultation for blepharoplasty?
During your initial consultation, Dr. Chung will discuss your concerns about your eyes: are you concerned by the amount of loose skin? Does the texture of your skin bother you? Do you have puffy bags? Do your friends and loved ones say that you “look tired?” Dr. Chung will also carefully evaluate your medical history, paying special attention to any prior history of eyelid surgery, dry eyes, or the use of blood thinners. During the physical examination, Dr. Chung will carefully assess the amount of skin laxity, the amount of fatty bags, and the position of the eyebrows.  Evaluating the position of the eyebrow is important in the discussion about realistic outcomes. As we get older, not only does the upper eyelid skin age and droop, but the position of the eyebrows will also drop. For some patients, Dr. Chung may also recommend a brow lift for optimal results.

What happens during the blepharoplasty procedure?
Typically, your upper eyelid surgery may be performed in the office under local anesthesia.  The procedure takes approximately one hour. You may take an oral medication such as Valium to help you relax during the blepharoplasty, and all patients need a ride home after the procedure. Dr. Chung will use a surgical marking pen to measure and mark out the planned incisions and the precise amount of skin to be removed. The skin is then cleansed with an antiseptic, and local anesthetic will be placed carefully in the eyelid skin. An incision is made along the natural crease of the upper eyelid, and excess skin is removed. Occasionally, the fatty bags may also be removed or repositioned, as well as possibly  a thin strip of muscle. Bleeding is usually quite minimal. All incisions are then closed with tiny, meticulously placed stitches. Antibiotic ointment is then placed on the incisions.

Complementary procedures
Many patients choose to have lower eyelid surgery at the same time as upper eyelid surgery for total eye rejuvenation. Some patients may also benefit from a brow lift at the same time to help refresh the upper third of the face.

What is the recovery like?
Immediately after surgery, there will be some mild swelling and possibly some bruising. This will get a little worse over the next 2 days before it gets better. Blepharoplasty causes very little pain. It is unlikely you will need to take any pain medications the day after surgery. You will ice your eyes for the first 2 days after surgery and will apply an antibiotic ointment such as Bacitracin to the incision line Dr. Chung will allow you to get the incisions wet on the 2nd day after surgery. Most patients feel great after upper blepharoplasty, but Dr. Chung asks that you refrain from exercising or strenuous activity for one to 2 weeks. Stitches are usually removed in 5-7 days. Once the stitches are removed, you may use makeup but need to be careful when removing the makeup so as not to pull on the incision line.

What will I look like?
The majority of the swelling and bruising will be gone in 1 -2 weeks, and there will be continued improvement for several months. The incision will also be slightly pink for a few months, but will fade and ultimately become barely visible. Most people will not even know you’ve had eyelid surgery!  You will have a wonderful refreshed quality, and those around you will comment that you look “rested” and “great,” but will not be able to place their finger on the cause. With blepharoplasty, you will experience firsthand how an improved look will inspire an improved outlook.

LOWER EYELID BLEPHAROPLASTY

Overview
The lower eyelids are one of the first areas of your face to show signs of aging. The eyelid skin is extremely thin and susceptible to the forces of gravity, genetics, and sun damage. In youth, we have a smooth youthful contour from the lower lash line to the cheeks. As we age, this smooth transition from the lower eyelashes to the upper cheeks gives way to hills and valleys. Fatty bags may appear and bulge. The cheeks also age and descend, exposing the bony rim of our eyes, creating a hollowed, skeletonized appearance to your face.  These changes may make you appear older and more fatigued than you really are!

In lower blepharoplasty –also known as lower eyelid surgery– excess skin and fat may be removed and/or repositioned around your eyes to create a natural, more awake, more vibrant appearance without changing your face’s shape.

It has been said that the eyes are the windows to our souls.  Our eyes are the defining features of our face and shape our interactions with others.  For these reasons, blepharoplasty is an extremely popular procedure. With the advanced techniques used by Dr. Chung, your blepharoplasty may be safely and effectively performed in the office under local anesthesia, with the expectation that you would be able to return to work within a week. Dr. Chung has performed countless eyelid procedures on her patients from the Boston area, including Brooklime, Wellesley, Newton, Needham, Andover, North Andover, Waltham, Salem, Peabody, Lynnfield, and the surrounding communities.

Am I a good candidate for blepharoplasty?
If you have excess lower eyelid skin and/or puffy bags around the eyes, you may be an excellent candidate for blepharoplasty. The best candidates for this procedure are healthy patients who do not smoke and do not have any serious eye conditions.

What happens during the initial consultation for blepharoplasty?
During your initial consultation, Dr. Chung will discuss your concerns about your eyes: are you concerned by the amount of loose skin? Does the texture of your skin bother you? Do you have puffy bags under your eyes? Do your friends and loved ones say that you “look tired?” Dr. Chung will also carefully evaluate your medical history, noting any prior history of eyelid surgery, dry eyes, or the use of blood thinners. She will also pay special attention to the surrounding anatomic structures such as the upper eyelids, cheeks, as well as the strength of the lower eyelid muscles.

What happens during the blepharoplasty procedure?
Typically, your lower eyelid surgery may be performed in the office under local anesthesia.  The procedure takes approximately one to two hours, depending on the type of procedure performed. You may take an oral medication such as Valium to help you relax during the blepharoplasty, and all patients need a ride home after the procedure.

Dr. Chung is skilled in all types of blepharoplasty procedures. For most patients, an incision is made on the skin just below the lash line. This allows excess, wrinkly skin to be removed. For others, the incision for the eyelid surgery may be placed on the inside of the lower lid. This procedure, called transconjunctival blepharoplasty, is best for those patients who only need fat removed and/or repositioned.  Ultimately, the decision regarding which procedure will provide you with the best results will be made after careful evaluation and discussion, carefully considering your goals and personal preferences.

During the procedure, Dr. Chung will measure and draw out the planned incision using a special surgical marking pen. The skin is then cleansed with an antiseptic.  Local anesthetic will be placed carefully in the eyelid skin. An incision is made just below the lash line and a conservative amount of excess skin is removed. Any fatty bags may also be removed or repositioned. Dr. Chung never removes too much fat, as she does not want your eyes to appear hollowed. Bleeding is usually quite minimal. All incisions are closed with tiny, meticulously placed stitches. An antibiotic ointment is then applied to the incisions.

Complementary procedures
Many patients also benefit from a skin resurfacing procedure, such as a chemical peel or the fractional laser treatment, at the same time as their lower eyelid surgery to improve the texture and fine lines of the lower eyelid skin. Some patients may also choose to have upper eyelid surgery at the same time for total eye rejuvenation.
For patients with deep tear trough changes and hollowing of the lower lids, Dr. Chung may also recommend Restylane injections to fill in the hollows and some upper cheek fillers.

What is the recovery like?
Immediately after surgery, there will be some mild swelling and possibly some bruising. This will get a little worse over the next 2 days before it gets better. Blepharoplasty causes very little pain. It is unlikely you will need to take any pain medications the day after surgery. You will ice your eyes for the first 2 days after surgery and apply an antibiotic ointment such as Bacitracin to the incision line. Dr. Chung will allow you to get the incisions wet on the 2nd day after surgery. Most patients feel great after lower blepharoplasty, but Dr. Chung asks that you refrain from exercising or strenuous activity for one to 2 weeks. Stitches are usually removed in 5-7 days. Once the stitches are removed, you may use makeup but need to be careful when removing the makeup so as not to pull on the incision line. You may also wear your contact lenses approximately a week after surgery.
Several treatment options are available for skin cancer and depend on type, location, and size. Complete removal of skin cancer may leave a sizable defect that requires reconstructive surgery to obtain favorable functional and cosmetic outcomes. Dr. Chung has significant expertise in skin cancer excision and reconstruction, having served as the Chief of Facial Plastic and Reconstructive Surgery at the Stratton Veteran’s Hospital in Albany, New York and collaborated with her many dermatology colleagues. Dr. Chung has removed and reconstructed several thousand skin cancers defects.
 

EARLOBE REPAIR

Overview
Overtime, wearing earrings may cause undesirable changes in the appearance of our ears.  The piercing site and the earlobe itself may elongate. The earlobes may tear or split from even the slightest pull on the earrings, leaving a conspicuous and unsightly appearance. In certain skin types, the earlobes may form keloids (benign but thickened scars), which may be disfiguring and prevent the use of earrings.

With earlobe repair, undesirable changes in the earlobe may be corrected to improve appearance, remove keloids, or allow continued use of earrings.

Am I a good candidate?
You are a good candidate for earlobe repair if you have:

  • a split or torn earlobe
  • an elongated ear piercing site
  • stretched  earlobes due to gravity and earring wear
  • keloid formation

What happens during the initial consultation for earlobe repair?
During the initial consultation, Dr. Chung will:

  • examine the earlobe and the severity of the tear, scarring, or stretch
  • make recommendations specific to the problem and discuss goals of treatment

What happens during the earlobe procedure?
Earlobe repair is a procedure that is performed in the office under local anesthesia.

For a torn or stretched earlobe:

  • the skin inside the tear is meticulously removed and a three-layered skin closure is performed. The three layered closure involves stitching the skin on the back of the earlobe, the subcutaneous tissue in the middle of the earlobe, and the skin on top of the earlobe. This complex closure prevents the formation of cysts and provide for the best cosmetic result.  Dr. Chung uses meticulous technique to ensure that the curve at the bottom of the earlobe is maintained. Sometimes a special procedure called a “z-plasty” may be needed.
  • Dr. Chung also injects fillers such as Restylane, Perlane, and Juvaderm into earlobes with piercings that have stretched but that have not torn all the way through. By plumping up the earlobe, the ear pierce opening is narrowed. At the same time, injectable fillers may transform thin, aged earlobe into a rejuvenated, more youthful earlobe.

For a keloid:

  • Dr. Chung uses the carbon dioxide laser or electrocautery device to remove the keloid. These laser or electrocautery procedures are followed by steroid injections into the area to prevent keloid regrowth.

What is the recovery like?
There may be some slight swelling after earlobe repair. Dissolvable stitches are used, whenever needed. You will be asked to apply antibiotic ointment on the incision for a week and will need to wait approximately 4-6 weeks before re-piercing your earlobes. Through experience, Dr. Chung recommends that new ear piercing sites be placed at a slightly different location, as the scar is weaker than the surrounding skin and may tear more easily.
With keloid removal, you will need to have steroid injections into the earlobe every few weeks for 1-2 months. Dr. Chung may also recommend that you wear special silicone pressure earrings to prevent regrowth of the keloid.

What will I look like?
The incision will be barely visible, and you will be happy that you can wear your earrings again. And for those patients who had a keloid removed, you will be happy that a disfiguring scar was removed.

SCAR REVISION

Overview
Facial scars may result from prior trauma, burns, accidents, medical conditions, or previous surgery. While some scars heal well and may be barely noticeable, other scars are quite conspicuous and may affect self-confidence and esteem. Besides being unsightly, some scars also affect the function of the eye, nose, or mouth.

Scar treatment depends on the cause, type, location, and age of the scar.  With her extensive surgical expertise and in collaboration with dermatologists, Dr. Chung has successfully treated many patients from Boston and beyond with various types of scars. Improving and minimizing the appearance of a scar can provide dramatic improvements in self-esteem, confidence, and well-being.

Am I a good candidate for scar revision?
You are a good candidate for scar revision surgery if you have:

  • good health
  • healthy and realistic expectation for scar revision

What happens during the initial consultation?
During your initial consultation, Dr. Chung will listen to your concerns regarding your scars and your goals for scar revision. A detailed history is taken to discuss the time of the scar formation, progression, and cause. A thorough examination will elucidate the type of scar that you have, as this will significantly influence subsequent treatment. Is your scar raised, wide, discolored, or depressed? Is it a shallow, crater-like scar or is it deep and narrow, like an ice pick scar? Is the scar affecting the function of any facial features, such as your mouth, nose, or eyes?  All of these considerations will be taken into account during your initial consultation.

Depending on your scar and your skin type, Dr. Chung will design an individualized treatment protocol specifically for you. Treatment options include:

  • serial steroid injections to flatten a raised scar
  • surgical excision of a scar with restitching to narrow a wide scar or change the direction of a scar. On occasion, serial excisions may be necessary to allow the skin to relax between treatments.  This is particularly true for wide scars.
  • surgical subcision may help elevate an “ice pick scar”
  • non-surgical procedures, such as carbon dioxide laser and dermabrasion treatments, may be used to help scarring from acne
  • other non-surgical therapies including silicone, Restylane, Juvederm, or Boletero injections to fill in depressed scars

These are just some of the treatment modalities available for scar revision, and Dr. Chung will customize an appropriate treatment regimen just for you.

Because each scar is unique and the patients’ attitudes toward scars so personal, maximum improvement in facial scars may require more than one procedure, employing more than one technique. Timing of scar revision surgery is also very important. Typically, it is recommended that a scar should mature for at least a year before revision is attempted. Dr. Chung also prefers to wait at least 6 months for patients who are completing a course of Accutane.

What happens during scar revision surgery?
Scar revision surgery is usually performed in the office with local anesthesia. For scars that are surgically removed, Dr. Chung uses meticulous technique to remove the scar tissue and move healthy adjacent skin to fill in the area. Some patients may require a skin graft from another part of the face, while others may benefit from z-plasty, an advanced technique in which the direction of the scar is moved from a visible area into a natural skin crease or fold. For all surgical procedures, Dr. Chung closes the skin with tiny, fine stitches.

In dermabrasion. Dr. Chung uses a special surgical device to treat raised scars. (This procedure should not be confused with microdermbrasion, which is a skin treatment delivered by aestheticians.) In surgical dermabrasion, the scar is sanded down to the point where there is punctate bleeding. The goal of this procedure is to improve the appearance of a raised scar, and blend the edges of a depressed scar with the surrounding skin.

In laser resurfacing, the carbon dioxide laser is used over the scar to promote collagen formation, soften any raised areas, and blend the edges of a scar with the surrounding skin. In these laser procedures, patients may feel some heat during the resurfacing, but the local anesthetic use makes it a very comfortable procedure.

If your scar is being treated with serial steroid injections, a tiny amount of steroid will be injected into the scar. This procedure takes a few minutes and will need to be repeated.

What is the recovery like?

  • If you have stitches, they will be removed in 5-7 days
  • For skin resurfacing procedures, the treated area may appear raw and red for a week.

Most patients return to work the day after the treatment. You may need to wear a bandage to protect the treated area for a few days.

What will I look like?
The treated area will continue to improve in appearance over time. It is important to have realistic expectations and realize that scars cannot be erased completely. In some patients, repeated treatments with skin resurfacing techniques (dermabrasion and C02 laser) may provide further improvements. Dr. Chung will also direct you on the use of post-procedure scar creams and sun protection to enhance the results. With scar revision, you will see how an improved look inspires an improved outlook.

 

 

 

 

 

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The Rockoff Dermatology Center

Andover, MA Dermatologist The Rockoff Dermatology Center 28 Andover Street, Suite 235 Andover, MA 01810 (978) 475-9230 Dermatologist in Andover, MA Call For Pricing Options
Brookline, MA Dermatologist The Rockoff Dermatology Center 1101 Beacon Street, Suite 1E Brookline, MA 02446 (617) 731-2390 Dermatologist in Brookline, MA Call For Pricing Options