Minor surgeries involving excision of moles, cysts and other lumps under the skin are performed right in our office.

Everything is done under local anesthesia, using 1% lidocaine injections.  These are usually well tolerated by the patients.  When there is also a concomitant infection or inflammation, there is more pain involved.  This is why it is preferred to remove skin and subcutaneous conditions when they are quiescent, i.e. not causing immediate problems. 

Usually a minor surgery in our office takes from half an hour to forty-five minutes depending on the size and the complexity of the problem we are dealing with.  Facial skin lesions (problems) take longer because of greater time and effort dedicated for best possible visual outcome.  

Most excisional wounds heal in such a way that they are impervious to water in approximately 48 hours.  Until then, it is recommended that the wound be kept dry as much as possible.  The timing of shower or washing face is not as important as keeping the wound dry for about 48 hours.

In most procedures in our office, we close the wound with absorbable sutures so that the sutures do not have to be removed.  However, we do require that the patient return to our office in about 5-10 days for the wound to be examined and the diagnosis to be explained to the patient.

It is very difficult for a lay person - even some physicians - to distinguish a cancerous mole from a benign mole when it looks "suspicious."  See Melanoma in Moles and Warts for the ABCD's of Melanoma.  The best approach is to find a dermatologist or an experienced physician to follow all moles and skin spots one your body periodically over time.  Any mole that is growing in size, changing in shape or color, or becomes itchy and bothersome should be biopsied.  If there is any question, it is best to have them be removed surgically, which can be done in an office-setting.

Subcutaneous cysts such as epidermal cyst or follicular cysts can episodically get inflamed, big and red, then spontaneously resolve.  When they become symptomatic like that, it is best to have them be removed.  The best time for excision is when they are "quiescent," that is, when they are not infected and inflamed.  The excision is much simpler with much smaller scar.  When they become infected, especially in the presence of abscess that requires incision and drainage, the incision tend to become larger, scar formation is less appealing, and pain and discomfort before-during-and-after the procedure tend to be much worse.  A bad subcutaneous abscess can significantly alter one's life temporarily, and therefore, it is best to avoid this in advance if at all possible. 

Yes, when the diagnosis is in question at all, we send it to a pathology lab for a definitive diagnosis. 

The word laser comes from the term, Light Amplification by Stimulated Emission of Radiation (LASER).  The wavelength emitted by medical application Lasers do not pose harmful health effects typically associated with X-rays.   

Aesthetic Laser is highly effective in removing hair inside the skin.  The precise wavelength-laser energy penetrates the skin to the approximate depth of the hair follicle.  When the hair follicle is in a specific phase of its growth cycle, the melanin in the follicle absorbs the energy and as it heats up, the hair follicle is destroyed without damaging the surrounding tissue.

It is highly effectively in removing the hair follicles that are treated.  However, an area of unwanted hair, whether it be in the underarms or in the groin area, has all of its hair follicles in various phases of its growth cycle.  The laser energy can destroy the hair follicles only in one particular phase, and therefore, it takes at least a few sessions to be able to get all of the hair in a given area. 

The discomfort is only very minimal.  Each pulse of laser delivered lasts a fraction of a second.  Sometimes there is no pain or discomfort that is experienced.  Commonly, only a tingling sensation is felt.  Sometimes in a sensitive area such as around the upper lips, a light pinch or a prickly sensation is experienced. 

Our Cynosure Elite laser hair removal system can vary its delivery parameters to deliver precise, customized treatment for people with various hair and skin colors. Hair removal is possible with most patients. Even some "blonde" patients can benefit from laser hair removal. In very light blonde patients, however, the benefit may not be significant as the laser may not work because of lack absorption of its energy by melanin-lacking hair follicles.  To be sure, you can obtain consultation with our staff to go over the specifics of your hair and skin color and the strategy for hair removal specifically designed for you. 

Similar to the mechanism of hair removal, our Cynosure Elite machine is able to change its laser delivery parameters to target the very superficial veins under the skin.  When the laser penetrates the skin to the specific depth where the vein exists, the pigmented components of the blood will heat, coagulate, and destroy the vein without much damage to the surrounding tissue.  Over the ensuing days, the body's natural inflammatory response will gradually heal and the result is depigmented, invisible tissue without the ugly veins. 

Sizable spider veins may take 2 -3 sessions with about 4-8 week intervals in between the sessions. Tiny facial veins or spider veins of the leg may take less number of sessions, and often disappear altogether after just one session.

Patients undergoing Aesthetic Laser treatment for spider veins are advised to avoid sun exposure or UV tanning salons for 3-7 days prior to the procedure, and for the duration of laser treatment until 6-8 weeks after the last session of treatment.

Similar in mechanism to the removal of hair and spider veins, the laser energy is absorbed by the pigmented components of the skin, namely the melanin in the aging spots.  The result is that of pigmented cellular destruction, inflammation, and gradual resorption and healing that leads to disappearance of the aging spots.

It’s a common affliction affecting nearly 25% of women and 15% of men, mostly associated with heredity, pregnancy, obesity, or aging.

Venous reflux.  Normally, one-way valves in the leg veins facilitate blood return to the heart when you walk and contract the leg muscles. Due to heredity, pregnancy, obesity or aging, veins become less elastic and dilated causing the valves to malfunction. This causes the blood returning to the heart to leak downward (reflux).  The superficial veins in the leg become tortuous and rope-like, leading to a variety of symptoms.

When venous reflux is mild to moderate, symptoms usually are leg pain, swelling, heaviness, itchiness, cramps, restlessness, and throbbing ache.  When severe, you may develop leg swelling, discoloration, chronic dermatitis, chronic ulcer, or bleeding. 

Eczema, dark pigmentation, severe leg swelling associated with skin ulcers, intermittent bleeding, and rarely, blood clots. 

No.  It hurts too much and can cause significant problems after surgery.  It also is not as effective as endovenous laser ablation treatment. 

Endovenous (“inside the vein”) laser ablation is a non-surgical  alternative to vein stripping.  Through a tiny puncture in the skin, a catheter is advanced to the problem vein segment in the leg, and laser energy is delivered through the catheter tip.  The vein segment is simply sealed and closed.  The basic cause of the disease is thus taken care of, leading to improvement of venous reflux symptoms.  Endovenous ablation can also be performed using radiofrequency energy.  

No. The venous blood flow in the faulty vein system will simply divert to the normal veins and return to the heart.  Blood flow is actually improved by closing the abnormal, refluxing veins.

It is 95%-97% effective in closing the diseased  vein.

No.  This is an office procedure lasting 45 minutes to one and a half hours using only a local anesthetic.  Afterwards, the patient walks out of the office without significant discomfort.

After ultrasound examination, your leg will be cleansed with a sterile solution and covered with a drape.  Your leg will be treated with a topical anesthetic cream.  Additional local anesthetic will be administered in the skin puncture site, usually just above or below the knee.

After the vein is located, a laser catheter will be inserted into the vein and advanced up to the top of the leg.  Precise positioning of the catheter will be checked with the ultrasound.  More local anesthetic is administered along the length of the vein to make absolutely sure that you do not feel anything.
 
 Laser energy is delivered to seal the vein as the catheter is withdrawn.  There will be no pain as the collapsing vein is numb.  Afterwards, your leg will be placed in a compression stocking, and you walk out of the office with follow up instructions.

Laser treatment itself is painless as the vein will be numbed.  Sometimes local anesthetic injections may sting briefly even with topical anesthetic cream, but most patients do not seem to mind.  

There will be some pain, swelling and a bruise temporarily afterwards at the treatment site, but the discomfort is easily alleviated with Advil or Aleve.  While seldom needed, narcotic pain pills can be prescribed if necessary.

Major risks are rare.  The most important risk can be formation of blood clots after the procedure.  This is extremely rare (less than 1%), but we confirm that it hasn’t happened by routinely obtaining an ultrasound examination within a week after the procedure.  Minor risks are also uncommon but includes minor skin burn, bruising, numbness, inflammation, and pain.

You will wear a compression stocking after the procedure to improve the effectiveness of the procedure and help reduce pain and swelling associated with the procedure.  You can resume normal activity immediately.  Vigorous exercise, long car rides or air travel should be avoided for at least two weeks.

Depending on the physical demands of your work and your sensitivity to pain, usually one to three days of rest from work is sufficient.

Yes.  Use of lasers inside the body has proven to be both safe and effective for a variety of surgical conditions and is commonly practiced every day.  In the experienced hands of a qualified surgeon, it creates less trauma and complication than open surgical techniques.  This is certainly true in the case of varicose vein treatment.

If you have symptoms of leg discomfort, pain, swelling or ulcer, the procedure is usually covered by most insurance policies and Medicare.