Facial Plastic Surgery
- Why choose a facial plastic surgeon for your procedure?
- Who should consider a facial rejuvenation procedure?
- Facial Rejuvenation Procedures
- Non-Surgical Facial Rejuvenation
Skin Cancer Treatment
|Excised Skin Cancer||Sutured Incision|
Why Have a Facial Plastic Surgeon treat skin cancer?
The number one goal of removing a skin cancer is a complete excision of the lesion. There are several types of specialists (e.g. facial plastic surgeons, plastic surgeons, dermatologists) who are well qualified to remove skin cancers and achieve an acceptable cure rate. The question is, who will get the best result?
Facial plastic surgeons are uniquely qualified not only to fully excise a skin cancer but to also repair the defect in a manner that has the most aesthetically pleasing result. After completing an approved residency, usually in Otolaryngology, Head & Neck Surgery, a facial plastic surgeon completes a rigorous Facial Plastic & Reconstructive Surgery fellowship, followed by a comprehensive oral and written exam. With the knowledge of the underlying structures of the face and neck coupled with the additional training, a facial plastic surgeon is able achieve a cure with minimal disfigurement.
How is skin cancer diagnosed and treated?
Skin cancer is diagnosed by removing all or part of a growth and examining the cells under a microscope (biopsy). Skin cancer can be treated by a number of methods, depending on the type of cancer, its stage of growth, and its location on the body. Dr. Lieberman is well trained and experienced in the excisional techniques of skin cancer surgery as well as in the subsequent reconstruction. By planning ahead for the reconstruction, he can plan the most appropriate incision to remove the skin cancer.
Any time that an incision is made in the skin, there will be a scar. The goal is to minimize and camouflage this scar. Dr. Lieberman accomplishes this by orienting the incision to remove the skin cancer in a direction that will leave the least noticeable scar. There are natural lines on the face and neck and when an incision is parallel to one of these lines, the scar is not as evident as one that runs in a different direction. This attention to aesthetics is important to patients, especially when the features of the face are involved.
When a skin cancer is small, the procedure may be a simple excision, closed with very tiny sutures, leaving a thin, barely visible scar. If the cancer is larger in size or has spread elsewhere in the body, a more complex surgery may be required. For instance, Dr. Lieberman may need to use local “flaps” to move nearby skin around to close the defect. This method helps to leave a shorter, less conspicuous scar without needing to use a skin graft. In other situations (e.g. a defect that is too large to close by bringing the sides together), he may need to use a graft in which case he will harvest skin that resembles that of the affected area.
Recognizing skin cancer
Basal cell carcinoma and squamous cell carcinoma are the most common types of skin cancer and may appear as:
- A small, white or pink nodule or bump
- Smooth and shiny, waxy or pitted on the surface
- A red spot that's rough, dry or scaly
- A firm, red lump that may form a crust
- A crusted group of modules
- A sore that bleeds or doesn't heal after two to four weeks
- A white patch that looks like scar tissue.
Both types enlarge locally and slowly over time and usually do not spread (metastasize) to distant parts of the body. With time, however, either type can invade adjacent structures. Early detection and treatment is key to minimizing the cosmetic defect.
Malignant melanoma is a very aggressive form of skin cancer that can rapidly spread to other vital organs of the body. Accounting for 80% of all skin cancer deaths, malignant melanoma is the deadliest type of skin cancer. It is usually signaled by a change in the size, shape, or color of an existing mole, or as a new growth greater than 6mm in diameter on normal skin.
The ABCDE criteria developed by the American Cancer Society provides an easily remembered guideline to use in self-examination for malignant melanoma.
Other characteristics that alert Dr. Lieberman are ulceration, bleeding or any change in sensation, such as itching. Any lesion that has a history of change warrants a biopsy to make a definitive diagnosis.
When the skin is injured from a laceration or even a controlled incision, the body heals by forming scar tissue. Unfortunately, scars and wound healing can be unpredictable. The way a scar develops depends on many factors including how one’s body heals, the type of original injury, the blood supply to the area, the direction of the scar, the thickness and color of the skin, etc.
The appearance of a scar can range from nearly invisible to very obvious and disfiguring. They can be wide, sunken, red, raised, pale or even cause distortion of other parts of the face like the eyes or lips.
While no scar can be removed completely, Dr. Lieberman can often improve the appearance of the scar, making it less obvious.
When can a scar be revised?
Many scars that appear large and disfiguring initially may become less obvious over time. In some cases Dr. Lieberman may suggest treating a scar with steroid injections to reduce the nodularity of it. Because there are subtle changes to a scar as it heals, he recommends waiting some months before deciding to have a revision procedure. Dr. Lieberman will explain the options available and what is realistic in terms of a final result.
How are scars treated?
There are different ways to make a facial scar less noticeable. The procedures can be performed in his office with a local anesthetic. The treatment is determined largely by the size and location of the scar as well as the underlying reason for its presence.
Often a scar is simply excised and sutured closed, leaving a thinner, less prominent defect.
If the original scar lies across natural skin creases, Dr. Lieberman can make it look less conspicuous by repositioning it to run parallel to these lines. The goal is to make the scar more closely conform to the natural lines and creases of the skin. This is a special surgical technique known as a Z-plasty. In the Z-plasty procedure, Dr. Lieberman excises the old scar and makes new incisions on each side of it, creating small triangular flaps of skin. These flaps are then rearranged to cover the wound at a different angle, giving the scar a “z” pattern, thus better camouflaging the precipitating defect.
Some scars, especially those that are raised or caused by acne may be improved with dermabrasion resurfacing. While the scar will remain, it will feel smoother and be less visible.
Dr. Lieberman is very experienced in repairing any facial laceration regardless of how extensive or how it was caused (e.g. dog bite, sports injury, fall, car accident, etc.). He prides himself on closing the wound meticulously so as to end up with a scar that is as fine and delicate as possible. In most instances, the trauma can be repaired in our office surgery room.
|Laceration from a Chain Saw||10 days After Laceration Repair|
|Laceration from a Dog Bite||4 Months After Laceration Repair|