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Yahoo! -Health: Plastic Surgery
Although they rarely cause medical problems, skin lesions can be psychologically damaging, and treatment can greatly improve one's quality of life. However, in a procedure where one mistake can cause a permanent scar, it is very important to know your options and choose a qualified doctor. Below, Dr. Mark Mausner, a plastic surgeon and a member of the NTSA Professional Advisory Board, answers common questions and offers suggestions on how to choose a good physician.
What kind of methods exist for the treatment of skin lesions?
Common methods include excision, curettage, cryotherapy, ultrapulse CO2 laser, pulse-dye laser, and dermabrasion. Excision involves the cutting of tissue perpendicular to the plane of the lesion, and curettage involves scraping of the skin. Cryotherapy, which freezes the skin, can be an inexpensive option in some cases but can cause hypopigmentation. Dermabrasion is a surgical method of sanding the skin, and the ultrapulse CO2 laser treatment helps best to decrease the bumps. The pulse-dye laser produces bursts of heat that does minimal damage to surrounding skin and is the most advanced treatment available.
Are specific methods recommended for certain skin lesions?
Treatment for angiofibromas spans the range and is determined by the individual situation. Shagreen patches (leather-like surfaces) are usually removed by excision, ultrapulse CO2 lasers, dermabrasion, or cryotherapy. Forehead plaques are treated through excision or ultrapulse CO2 lasers which is the better option with less scarring. Periungual fibromas (pink, firm growths near nails) are taken care of through excision, ultrapulse C02 laser or curettage (more post-op pain than excision). In all of the cases, local anesthesia is used although those undergoing extensive angiofibroma treatment may prefer general anesthesia. Unfortunately, there are currently no treatments to re-pigment or blend the hypopigmented macules (ash leaf spots).
When is the best time to treat facial angiofibromas?
The growths should be treated immediately if they are bleeding or causing functional problems (obstruction of vision or of breathing. If the facial lesions are extensive or cosmetically disfiguring, it is best to treat these areas either before socialization or at the patient's request. In all of the cases, the mental status of the patient is a factor.
How do you decide what form of treatment is best for the facial angiofibromas?
The treatment form depends largely on the individual case. If there is a big cluster of angiofibromas on the base of the nose, for example, the surgeon may elect to use excision. If the objective was to minimize the redness, then a pulse-dye may be used. The ultrapulse CO2 laser is best for decreasing bumps. While some doctors may still use argon or the old CO2 laser, it is highly discouraged because they can cause significant scarring. A careful examination by your surgeon and a subsequent meeting with him should help determine the treatment method for you.
After receiving treatment for angiofibromas, will results be permanent? Will my face and skin look normal?
The lesions have a greater chance to recur in young maturing children (age 5-10), but they would grow at a slower pace and will be smaller. For adults, the new treatment options offer excellent results with less chance for scarring and recurrence. Patients can expect the skin texture to be considerably improved with a smoother look and feel. If the redness was treated with a pulse-dye laser, then the facial color would be better blended. It is important to realize, however, that the affected skin will never exactly resemble unaffected skin.
How painful is the procedure?
In general, pain is minimal except for local anesthesia on the face.
How long does the procedure take? How long is the downtime? How long does it take to heal?
The surgery takes anywhere from 30 to 60 minutes. If under general anesthesia, a couple extra hours for recovery is needed. In all cases, strenuous activity will be discouraged for a few weeks, but only in the case of extensive angiofibroma treatment will you be confined to the home for 7 to 14 days. It will take as long as six months for your face to be fully healed, and you will want to use sun screen for at least that long when outside.
What are the possible side-effects, and what can I do about it?
Post-operatively, you may experience nausea if general anesthesia is administered, but medication can minimize it. Otherwise, there may be some pain that can be relieved with Tylenol or a low-dose narcotic such as codeine or percocet. As the treated area starts to heal, there will be itching which can be taken care of with ice, cool packs, cream massage, or oral antihistamines such as benadryl. If a pulse-dye laser was used, purple spots will remain for two weeks. Utlrapulse laser treated area will be raw for 10-14 days before it heals and occasional crusting and pinkness can last up to six weeks (this can be covered with light make-up). In order to avoid scarring, it is imperative that post-operative instructions are followed closely, and you receive appropriate follow-up.
Does health insurance usually cover expenses?
In most cases, insurance companies eventually cover it, but they may initially refuse on grounds that the procedure is cosmetic. To avoid such trouble, you must work with your doctor to educate the company about TS. It is important to emphasize that angiofibromas are tumors due to a genetic disorder and could cause bleeding and infection. NTSA can help you provide the necessary back up.
What questions can I ask to assure the best care and weed out unqualified doctors?
Is he board certified? Does he have hospital privileges? If so, where? If the procedure is to be done in the office, is the suite certified for insurance reimbursement? How are emergency situations handled in the office (i.e. resuscitation etc.) Does he have experience in the use of various lasers? What kind of training has he had? Has he ever treated a patient with TS and does he understand their special needs? What has his results been? If there are post-op questions, is he available to respond?
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