Achieving aesthetically superior results: Tips and tricks

Dermatologic surgery can no longer afford to be just therapeutic; it needs to also be aesthetically pleasing, because skin is nowadays more for looks than life. I mean to say that regardless of the best therapeutic result we may deliver by performing a successful dermatologic surgery, patients nowadays will demand a postsurgical result that will be aesthetically superior. Patients are against suturing, they are against a hospital stay, and against visible dressings, visible scabs, and obvious scars. They seek blemishless skin, hence they expect skin lesions to be removed without leaving any scars. They are influenced by the media which always glorifies skin, praising “flawless skin.”

Patients read and express their demands directly through “straight talk.” But, with our experience we need to read in between the lines and fill in the gaps left by them.

Here, I would narrate some examples from my practice. Patients ask for keloids to be removed without leaving any scars, to clear acne scars by “laser” without leaving any marks, remove any and all unsightly moles on the face or even covered areas without leaving scars, demand ear lobe repair without suturing, and many other requests. They are reluctant to have even the smallest of dressings. They have some unimaginable and fantastic ideas of anything and everything getting cleared with lasers. The word laser is supposed to be a magical and last word for skin lesions or blemishes, so much so that if I tell them that I will be performing their procedure with radiofrequency, they are lost and sometimes look toward me with a question mark on their faces. But, here’s the scoring point for radiofrequency surgery. I will tell you how.

Radiofrequency surgery has one of the thinnest cuts in surgery, as you are aware now. In addition, it is a skillful work, which when learned gives the best and unbelievable final results so much so that our own patients become our walking and talking advertisements. Believe me, I have never really spent my money on advertising radiofrequency surgery results. Many of my walk-in patients come to me through word of mouth. This was possible because of the aesthetically superior scar after surgery and the ease of surgery in an office.

Tips for Aesthetically Superior Results

I would like to give you some of my tips for an aesthetically superior result:

While examining patients, always judge the depth of the lesion concerned (whether the lesion is in papillary dermis, i.e., the lesion is within 1 to 2 mm from the skin surface). This is vital as all epidermal and lesions up to the papillary dermis when removed with radiofrequency surgery are unlikely to produce scars. I say this confidently because I have experienced the very thin cut of radiofrequency surgery (10–20 microns). It cuts only the part you wish to. It will never damage the close-by skin tissue.
Even if you are removing a deeper lesion like dermatofibroma or neurofibroma, always do blending after the excision.
Try to remove lesions without suturing; allow secondary intention healing.
The blending trick should be universally implemented for all lesions except those on the scalp (hairy), palms, and soles.
Even atrophic and hypertrophic scars should be blended into surrounding skin.