Sometimes patients come to our office with lesions (warts, moles, seborrheic keratoses, sebaceous hyperplasia, fibrous papules, fibroadenomas, and small growths) that they would like removed. They are not necessarily dangerous or premalignant, but some may be unsightly or rub on clothing, seatbelts, or glasses, and then become inflamed, bleed, or become infected. In most cases this is cosmetic and not covered by your insurance company. The key word is ablative - the lesion can be destroyed. Depending upon the nature of the lesion, the size, your history of scarring, your tolerance for pain, your skin color, your finances, and even your business, school, social and travel schedules, we will pick an ablative method that would be most comfortable and most appropriate for you. This may include light acid peels, the pinpoint application of a potent acid (bichloracetic acid - BCA), lasers, cryosurgery (liquid nitrogen freeze), scraping, burning, and so forth. In each case, we will discuss the reasons for our choice with you and make a joint decision what would best accommodate your needs. In many cases no anesthesia will be necessary; in some cases topical anesthesia will be appropriate or we may even inject pinpoint local anesthesia. In every case some evidence of this treatment will be visible - adjust your travel, work, school and social calendars accordingly. In some cases there will be pinpoint scabs which will last one to two weeks, and in all cases we always recommend keeping the treated areas moist with an antibiotic ointment (not cream) for the first week. We don't want a dry scab to form - we want to keep it greasy. Washing should be with a gentle soap such as Dove Beauty Bar, and just the fingertips. Common sense is to be applied at all times - avoid smoking, excess sun exposure, and never plan such treatments before an upcoming social event or before trips, particularly involving exposure to the sun.
Some lesions have a propensity to regrow such as sebaceous hyperplasia, and if so, please understand that some of the lesions may be destroyed completely, others will be flattened to some degree, but some may even regrow with time. We cannot guarantee the complete permanent erasure of every single lesion because that might involve too much destruction in the first place. It is better to treat conservatively and retreat later if needed. All subsequent treatment sessions are always at full price in effect at that time. Some lesions may disappear completely, others may be 50% better, but there will always be improvement. Please understand, some lesions may regrow. There is no "lifetime cure." There are no free touchups. Side effects of any ablative treatment can include but are not limited to: discomfort during the treatment; bleeding depending upon the procedure (especially scraping); pinpoint scabs which may be visible; flare of underlying herpes whether known or not (we will give you pre and post-treatment medications for this); sun sensitivity; the possibility of pigmentary changes whether lighter or darker which may be permanent; decreased hair growth in the treated areas. There can be scarring.
All of these will be discussed with you depending upon your history and exactly what type of lesion you have and how we will decide to treat it. You will be fully informed as to these issues, and of course we will discuss fees and alternatives. In all cases we will choose the method that is easiest for you, the least expensive, the least invasive, and one with the quickest recovery time. Sometimes "low tech" trumps "high tech." Many patients often come in asking for a laser or perhaps their doctor referred them here for laser treatment. Dr. Coverman and Jennifer constantly read and try to stay abreast of the latest treatments for you, and we will always select what would be most appropriate for your circumstances whether laser or not. Part of our decision will also include your occupation, your travel schedule, your tolerance for pain or discomfort, your skin color, and of course the nature, size, and number of the lesions themselves.
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