Staged Excision

December 30th, 2015

So birthmarks on the face are a touchy thing. The best we can usually do is trade them for a scar and hope the scar comes out better than the birthmark. With VERY light brown birthmarks there is some role for laser treatment, but sadly that’s not most people’s.

Removing these things gets complicated when there’s an eyebrow or an ear involved. If that’s not you, you’re lucky. If you do have facial structures involved in your birthmark, don’t give up – it just requires creative solutions in terms of scar placement and skin replacement.

Some birthmarks (especially on the face) are best removed in two stages. There are two primary reasons for this – and they go hand in hand. First – the more tension on a scar, the more the scar will widen and the less pretty it will look. It may be irregular and even a little bumpy. So by removing most of the birthmark at the first stage, I place the most tension on the skin with the initial scar. When I go back for the second stage and take the second, smaller, and final excision, the skin will have stretched from the first excision and will have less tension on it for the second scar – so the permanent one is prettier.

The second reason is the length of the scar. As I have illustrated below –

One Stage

staged excision


Two Stage

Staged Excision 2

The first excision (red) of the nevus (blue) will leave a longer scar because I have to elongate the incision to avoid having the skin pucker when I close it. In the second set of incisions (two stages) I make my incision barely longer than the nevus, excise most of it in the first stage, and then return and excise a narrower nevus the second time to end up with ultimately a shorter scar.

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