Moles, Lipomas, Cysts, Osteomas and Scar Revisions

“There is no such thing as minor surgery, only minor surgeons.”

Key highlights

  • Surgery for moles, lumps, cysts, bumps, osteomas and unsightly scars, is not minor surgery. Moles, lumps and bumps, etc., are often in highly visible locations such as the upper lip or the cheek. A botched surgery can be impossible to correct. Because it is often called minor surgery, patients might choose a dermatologist, a facial plastic surgeon or cosmetic surgeon instead of a Plastic Surgeon like Dr. Kirwan who is certified by the American Board of Plastic Surgery.

Patients have high expectations because they think it is this kind of surgery is a simple procedure and they are then disappointed if they don’t get the result they expect. A board -certified Plastic Surgeon with rigorous surgical training and an understanding of the natural skin crease lines and the anatomy is essential. Badly planned surgery may well result in a scar that is as visible or even worse than the original problem! An excision and a scar in the wrong orientation may cause distortion of facial features such as the lip, eyelid, cheek or eyebrow. If the resultant scar is near a joint, such as the shoulder or the web space between the fingers, there may be a limitation of motion or webbing across a concavity.

Moles are various shades of brown but may also be non-pigmented. They may be raised above the skin or flat like a café au lait macule which is coffee colored and is not usually considered for a removal like a raised mole.

  • Moles are often present for many years. They can get bigger over time. Some moles are present at birth and are called birthmarks. Some patients have lipomas which are fatty tumors beneath the skin. Moles and lipomas are benign and should be distinguished from skin cancers (link to skin cancer page) which require more extensive removal to remove a margin of normal tissue to prevent a recurrence.
  • Some people have a lot of moles or lipomas all over their body. Others have just one or two. Facial moles are more visible and can be hairy and unsightly. Moles can also be considered beautiful. Marylin Monroe, Cindy Crawford, Madonna, Eva Mendez and Blake Lively have all flaunted their moles. Mostly, moles are a visual distraction which detracts from other facial features. Just think of that scene from Austin Powers with the mole. You can find it on YouTube.  In men, moles are often raised and bleed when shaving. Moles on the back are hard to see and should be monitored for any changes in appearance.
  • There are other lumps and bumps such as lipomas, cysts and osteomas. Lipomas are fatty lumps under the skin that get bigger over time. Some are deep and have multiple extensions, close to the muscle layer. Other lipomas are just beneath the skin layer and are easily removed. Cysts are lumps, often attached to the skin, that may drain whitish material. These are called sebaceous cysts. Sebaceous cysts frequently get infected and should be removed. Other bumps may result from insect bites. These are called dermatofibromas and are usually seen in the legs.  Osteomas are bony bumps, usually on the forehead. They are often shaped like a mushroom, with a narrow stalk, and can be removed through an endoscopic approach using an incision hidden behind the hairline.
  • All moles, lumps and bumps should be removed completely so that they do not grow back. If pieces are left behind, they will reoccur and need another surgery. Although lipomas are made of fat, they should not be removed with liposuction. This results in incomplete removal and the likelihood of a recurrence.
  • Moles, lumps and bumps should be removed through incisions that are parallel to natural skin creases or wrinkles, sometimes known as Langer’s Lines. If the incision is not in a wrinkle line it will stretch and may even pull apart, causing a widened scar.If a scar crosses a joint or a concavity it should be interrupted with a z-plasty. You can read more about z-plasties in the Scar Revision section.
  • Moles, lumps and bumps are collectively called lesions. They are called lesions rather than moles etc., because the final diagnosis depends on the histopathology. This means that the lesion is examined under a microscope by a pathologist who identifies the type of mole and makes sure that it has been completely removed and is not malignant. I recently removed a ‘sebaceous cyst’ from behind the ear, only to find out that it was a skin cancer! Appearances can be deceiving!  Even lipomas can become malignant. Always make sure that the lesion is submitted for a histopathological diagnosis. An exception to this rule would be a skin tag.

When to Consider Surgery

When to consider surgery is a personal decision. Moles, lipomas and osteomas not only get bigger over time but are often unsightly. Moles and cysts may interfere with shaving and bleed. Sebaceous cysts can get infected. Lipomas may be visible under clothing and may rub on a bra strap. All of these moles, lumps and bumps have the potential to change and become cancerous. Any lesion that is getting bigger or changing in appearance, should be removed. Multiple moles or lesions can be removed at the same time. See also Skin Cancer Surgery.

Information for Kirwan Plastic Surgery Patients

The best decisions are informed decisions. Dr. Kirwan can help you learn more about removal of moles, lumps and bumps. Dr. Kirwan can also discuss other treatment options and provide more personalized answers based on your individual needs. You can schedule a consultation for surgery in Norwalk with Dr. Kirwan.

Preparing for the Procedure

After making your decision and choosing Dr. Kirwan, the next step is a consultation. Be prepared to discuss your expectations, medical history, previous procedures, and history of a prior keloid scar that could affect the outcome of your procedure.

During your consultation, Dr. Kirwan will examine you and take photos of the mole to review with you and to help you understand the planned surgical technique, the resulting scar and the possible benefits of surgery. Dr. Kirwan will also show you examples of his own ‘before and after’ surgical results.

What Happens During Surgery

Surgery is performed under local anesthesia. Dr. Kirwan will perform the surgery as discussed in your consultation.

Procedure Options

Dr. Kirwan may perform one of several techniques, such as:

Mole excision alone.

  • Ideal for patients who have no other associated problems.
  • Incisions are made in natural wrinkle lines.
  • Deep stitches are used to keep the wound supported until the scar matures.
  • Plastic dressings are often used so that you can shower.
  • Length of surgery depends on size and number of lesions removed.
  • Outcome: Ideally, removal of an unsightly lesion and a thin almost invisible scar that fades over time.

Mole excision combined with other surgery.

  • Ideal for patients who would benefit from another procedure at the same time.
  • Length: varies.

Results and Recovery

It will take some time to fully recover and see the final result. However, patients can usually return to work either immediately or within 24 hours and may resume other activities, like working out, in approximately 3 to 4 days, depending on the specific surgery, and the activity. Contact sports should be avoided for at least three to six weeks. If the incision is traumatized, it may open, requiring further surgery.

After surgery, there is a small amount of bleeding for 24 hours. You may experience some swelling and bruising. To reduce swelling, you can use ice packs for the first 48 hours. Be sure to follow the instructions provided by Dr. Kirwan and his staff before and after your surgery to ensure a smooth procedure and recovery.

All scars are red soon after surgery. Scars fade to a thin white-line scar over a period of several months. It is important to protect the scar with sunblock during the healing period to make sure that it does not become pigmented. Dr. Kirwan will recommend a sunblock and a scar cream to promote healing and help prevent the formation of a thickened raised keloid scar.


Before & After Photos