Stephen McCulley, Reconstructive and Aesthetic Surgeon. MBChb, FCS(SA)Plast, FRCS(plast)

Frequently Asked Questions

Moles

Why would I need to get a mole removed?

In many cases, moles are removed for cosmetic reasons. Some people consider them to be unsightly and a cause for embarrassment and others find them annoying if they repeatedly get caught on clothing.

There are also cases where moles may be malignant and need removing for health reasons.

How will I know if a mole is dangerous?

The majority of common moles are benign and are no cause for concern, however if you notice anything unusual about a mole it is essential that you get it checked by a medical professional.

Warning signs that may indicate a malignant mole include:

A – Asymmetrical shape. Benign moles are symmetrical, so if you have an asymmetrical mole it may be a sign of Melanoma.

B – Border. The border of a malignant mole may be scalloped and uneven, whereas a benign mole will have even, smooth borders.

C – Colour. Benign moles are usually a single, even shade of brown. If a mole is uneven in colour, or if it contains a variety of colours (such as black, white, tan, blue or red), it could be an indication of Melanoma.

D – Diameter. The diameter of a malignant mole is usually larger than benign moles.

E – Evolving. It is important to look out for any changes that may be happening to moles, in particular, any changes in size, shape, elevation or colour.

What is the procedure for getting a mole removed?

Common, benign moles can be removed using two different methods:

Direct Excision – This method involves removing the mole completely from beneath the skin surface.

Shave Excision – This involves cutting the mole off to leave it flush with the skin surface.

During your consultation, you will be able to discuss the best treatment for your personal situation.

What are the pros and cons of Direct Excision?

PRO: Direct Extraction will ensure that the mole is completely removed and there will be no chance of it recurring.

CON: This method will leave a slight scar, approximately 2-3 times the width of the mole. It will heal and fade over time, however it will be reddened for a few weeks after the surgery.

What are the pros and cons of Shave Excision?

PRO: Shave Extraction will not leave any scarring.

CON: There is a 30% chance of the mole recurring.

What are Sebaceous Cysts?

Sebaceous Cysts are lumps on the skin that are generally filled with a yellow fluid. They occur as a result of sebaceous/oil glands becoming blocked.

What does the process involved for removing Sebaceous Cysts?

The procedure of removing sebaceous cysts involves the surgeon making a small opening in the skin and extracting both the cyst and the blocked pore.

What are skin tags?

Skin tags are small flaps of skin that commonly occur in areas where the skin is frequently rubbed, for example, under the breast where it comes into contact with the bra, or on the neck or chest where straps may rub.

Pregnant women often develop skin tags, as a result of hormone changes, and it is also common for overweight people to have skin tags in places where skin rubs against itself, or against clothing. Older people and those suffering from diabetes are also prone to developing skin tags.

How are skin tags removed?

In most cases, skin tags can simply be shaved off under local anaesthesia. It is a very quick procedure and patients experience very little discomfort or pain. Skin tag removal rarely leaves any kind of scarring.

How much does it cost to have moles and cysts removed?

The price for removal procedures starts at £300. Your private consultant will be able to advise you after a thorough consultation of your individual case.

Scars

Why would I choose to undergo Scar Revision surgery?

A surprising number of people have poor quality scars that are a result of wounds that haven’t healed very well. There are a number of reasons why wounds are unable to heal properly, including:

  • Poor stitching.
  • Tension in the wound.
  • A foreign body in the wound.
  • As a result, scars can be unsightly and could possibly cause embarrassment and discomfort. Scar revision surgery can work to help minimise and reduce the appearance of these kind of scars.

What does the procedure involve?

There are several different approaches to treat and revise poor scarring, and a thorough consultation prior to treatment will determine the most suitable method for each individual case. The different methods include:

  • Direct Excision.
  • Steroid Injections.
  • Silicone Tape.
  • Silicone Gel.
  • Pressure Garments.

What is Direct Excision?

Direct Excision involves cutting out the old scar tissue and using the healthy tissue that surrounds the wound to reclose it. This will still leave a scar, but it will be smaller, neater and less noticeable.

How do Steroid Injections work?

Keloid scars are formed by a build up of a rubbery material called collagen, this is created by a build up of cells around the scar called fibroblasts. Steroid injections work by preventing these cells from producing collagen and the steroids also help flatten the scar by weakening the collagen. Steroids also work to reduce any itchiness and tenderness.

What will silicone tape or gel do to help reduce scarring?

Silicone gel or tape can help flatten the scar and it can also work to minimize hyperpigmentation of the scar. Tenderness and itching can also be alleviated by silicone.

How does applying pressure to a scar work?

Applying pressure to a well healed scar, (whether through a garment or through massage), will help break down the scar tissue and subsequently improve the overall appearance of the scar.

Is Scar Revision surgery suitable for everyone?

Unfortunately, some people are prone to scarring badly, and therefore scar revision surgery will not alleviate the problem. In some cases, the additional surgery may even incur further poor scars. The two common types of healing problem are Hypertrophic Scarring and Keloid Scarring.

What is Hypertrophic Scarring?

Hypertrophic scarring is when the scarring is initially raised, and takes between 1-5 years to settle down. Once fully settled, hypertrophic scars are wide, pale and flat in appearance and they can also become thinned and slightly sunken.

What is Keloid Scarring?

Keloid scarring is thickened and red in appearance and the scar can grow well beyond the boundaries of the original scar. This type of scarring is more common amongst patients with black skin, however it is not exclusive to this skin type.

In time, the scar will become solid, but it will not shrink or flatten.

Does the surgery offer permanent results?

On skin that isn’t prone to poor scarring, most patients can expect permanent positive results from scar revision, although signs of scarring can never be completely eradicated.

However, whilst keloid scars will look better after they have been excised through surgery, it is important to note that it is possible for the scar to reform over time. Estimates of this happening range from between 20-100%, however from Stephen McCulley’s experience, he sites the chances as being 50%.

How much does it cost to undergo Scar Revision surgery?

The costs for scar revision surgery vary, depending on the severity of the scar and the type of treatment needed to treat the patient’s individual circumstances.

Scar revision surgery: from £750.

Steroid injections: from £85.

Silicone gel/tape: Between £20 – £50 depending on the treatment.

Skin Cancer

What types of skin cancer can be treated surgery?

All forms of skin cancer can be treated using surgery. The two main forms are melanoma and non-melanoma skin cancer, and Stephen McCulley is experienced in both diagnosing and treating all types. Three common types of skin cancer are:

  • Basal Cell Carcinoma
  • Squamous Cell Carcinoma
  • Cutaneous Malignant Melanoma

What is Basal Cell Carcinoma?

Basal Cell Carcinoma, also known as Rodent Ulcer, is the most common form of non-melanoma skin cancer, and in most cases it develops as a result of recurrent sun exposure. Unlike other forms of cancer, Basal Cell Carcinoma does not spread around the body, however it is still advisable to obtain treatment as soon as possible as this type of tumor tends to grow resembling the roots of a tree, and may spread under the surface of the skin if it is ignored.

How would I recognize if I had Basal Cell Carcinoma?

Basal cell carcinomas vary in appearance. Sometimes they can appear as a flat scaly mark, in other cases they may present themselves as a pearl-like rim surrounding a central crater. If you have an unusual mark on your skin, it is always recommended to speak to a medical professional as soon as possible, as early detection of skin cancer increases the chances of it being successfully treated.

What is Squamous Cell Carcinoma?

Squamous Cell Carcinoma is the second most common type of non-melanoma skin cancer. This form of cancer can spread around the body through the blood stream, and is therefore essential to seek early treatment.

How would I recognize if I had Squamous Cell Carcinoma Cancer?

Squamous Cell Carcinoma doesn’t always present itself in the same way and can vary greatly from person to person. A common sign is a scaly or crusty area of skin, or lump surrounded by a red inflamed base.

What is Cutaneous Malignant Melanoma?

Cutaneous Malignant Melanoma is a cancer of the pigment cells of the skin. Whilst this form of cancer is malignant and can spread to other areas of the body, if it is diagnosed and treated quickly the outlook can be good.

How would I recognize if I had Cutaneous Malignant Melanoma?

Cutaneous Malignant Melanoma will often have an irregular edge, differ in colour and may also itch.

How is Skin Cancer treated?

Surgery for skin cancer will usually involve a direct excision, however different people may require more complex treatment to suit their specific case.

How soon after diagnosis can I have surgery?

As with all forms of cancer, early detection and treatment is essential, so the sooner you receive medical treatment the better. Generally, surgery is carried out shortly after diagnosis to prevent any chances of the cancer spreading or worsening.

Does the surgery offer permanent results?

With cancer, there can be no guarantees that it will not recur, however acting quickly and undergoing surgery to remove the tumor will give a patient the best possible chance of a full recovery.

How much does it cost to undergo Skin Cancer surgery?

The costs to undergo surgery to treat skin cancer varies from patient to patient. During your consultation, you will be advised on the costs, based on your own personal diagnosis.

Skin Resurfacing

What is Skin Resurfacing?

Skin Resurfacing is a cosmetic surgery treatment that involves removing the top layers of skin on the face, neck, chest and hands. This then allows fresh, new skin to emerge, which appears clearer and healthier than before.

The two main methods of Skin Resurfacing that we carry out here at Stephen McCulley are:

  • Chemical Peels.
  • Dermabrasion

Why would I choose to have Skin Resurfacing?

There are several reasons why a patient would choose to undergo Skin Resurfacing. Including:

As an anti-ageing procedure to treat:

  • Vertical wrinkles around the mouth.
  • ‘Crow’s feet’ around the eyes.
  • Skin laxity around the lower eyelids.
  • Fine wrinkling around the upper eyelids

As a restorative procedure to treat:

  • Sun-damaged skin.
  • Blemishes or blotchy skin coloring.
  • Precancerous skin growths.
  • Acne or chicken pox scars.
  • Facial scars from an old injury.

What is a Chemical Peel

A Chemical Peel is a technique where a chemical solution is applied to the face. This solution removes the surface layers of the skin to effectively treat most of the skin conditions described above. Stephen McCullay uses the Obagi System which is made up of 15-20% of Tri-chloracetic Acid, this is a very safe technique and the most common type of resurfacing procedure.

How is a Chemical Peel procedure performed?

When applied to the skin, the acid in the Chemical Peel essentially damages the top layer of skin, which then peels away itself after a few days. The advantage of this particular type of treatment is that the face remains ‘dry’ during healing as it does not leave a raw surface to heal. The deeper the layer of skin removed means a greater chance of a better result, however this also increases the chance of side effects (see below).

How long is the recovery time following a Chemical peel?

Following a Chemical Peel, the area that has been treated will be a little red and swollen for the first few days. For mild wrinkles a light peel will be used and therefore the patient can expect 3-4 days of peeling, compared to a deep peel that may last up to 14 days.

How long will I be off work following a Chemical Peel?

The recovery time will be dependent on the intensity of the peel, very little time will be needed for a light peel, however a very deep peel may take up to a fortnight to recover. There will be very little physical restriction after a peel, however, for cosmetic reasons, patients may with to be out of the work environment until they have made a full recovery.

What is Dermabrasion and how is it performed?

Rather than using a chemical treatment, Dermabrasion involves using a device to gently buff away the top layer of the skin. The device is small in size and has a spinning ‘head’ that is covered in a material similar to a very fine grade sandpaper.

Unlike a Chemical Peel, Dermabrasion is an operation and is therefore carried out in hospital, under local or general anaesthetic. Depending on the individual, it is generally used to treat acne scars.

How long is the recovery period following Dermabrasion?

The healing process for dermabrasion is slightly different from a Chemical peel. Instead of peeling away, the skin that has been treated will form a scab, which will then fall away once the skin underneath has healed. The time this takes will vary from patient to patient, however as a rough guide, patients should expect this to take a couple of weeks.

Skin will then remain quite reddened for a period of time, from several weeks, to several months. It is usually fine to use camouflage make up during this recovery time, however it is important to take medical advice before putting any products on the treated areas of skin.

How long will I be off work following Dermabrasion?

Similarly to a Chemical Peel, you will not experience any physical restrictions following the procedure, however you may want to take time away from work for cosmetic reasons whilst the skin heals. Once the scabs have come off, generally after two weeks, most patients feel ready to return to work.

How can I prepare for a Skin Resurfacing procedure?

Before having treatment it is important to prepare the skin and make sure it is the best possible condition. Stephen McCulley advises patients to start using certain creams including active ingredients (including Retin A and Hydroquinone) six weeks prior to treatment. This will enable the skin to increase its healing power and reduce the changes on the pigment cells in the skin. Patients usually notice a significant improvement on the skin before treatment.

Can I drive following a Skin Resurfacing procedure?

Driving should be avoided immediately after the procedure, however, patients can usually drive after a few hours or the following day. Patients should avoid driving until they are completely free of pain and restriction, and be able to confidently perform an emergency stop. This is to ensure that they will be covered by their car insurance policy.

How soon can I exercise following a Skin Resurfacing procedure?

Strenuous exercise should be avoided for the first 3-4 days following the procedure, and slightly longer for deep peels.

Can I take any medication around the time of surgery?

During your consultation a full medical history will be taken, and you can discuss any medication that you are taking. As a precaution, do not take any over the counter medicines or herbal remedies prior to surgery or for 3 days following. Also avoid aspirin, ibuprofen and Voltarol based tablets. It is always useful for patients to bring a list of any prescribed medications to the pre-op assessment.

I am a smoker, how will this affect the procedure?

Smoking can increase the chance of complications during surgery, so it is advisable to try to stop, or at least radically cut down around the time of the procedure.

When will I see the full effects of a Chemical Peel?

The results of a Chemical Peel will be visible once the peeling process has finished, and the colour and overall appearance of the skin will continue to improve over the first few weeks.

When will I see the full effects of Dermabrasion?

The results of Dermabrasion will be visible once the scab has fallen away to reveal the healed skin underneath. The overall appearance of the skin will continue to improve over the first few weeks, however some redness may still be visible for a couple of months.

What are the potential complications with Skin Resurfacing?

Skin Resurfacing is a routine procedure that is highly successful for the vast majority of patients. However, as with any procedure, it is very important you understand what can go wrong as well as right. The potential complications are listed below, most of which would only occur if the product used was too strong.

Pigment Problems

Although it is relatively uncommon, any resurfacing method can alter the pigment in the skin. This usually results in reduced pigmentation, but there is occasionally the risk of increased pigmentation. The risk of this occurring is greatly reduced by using creams containing active ingredients for 6 weeks leading up to the treatment.

Healing Problems

This can occur if the Chemical Peel is too deep and could potentially result in scarring. However, with Stephen McCulley’s technique this is extremely rare due to the amount (15-20% of Tri-chloracetic Acid) that is used in the procedure.

Redness

Most redness fades after a few weeks, although occasionally it can be visible for slightly longer.

Is there anything I can do post treatment to assist healing?

It is essential that you avoid direct or indirect exposure to the sun following treatment, and at all times until the redness of the skin has subsided. Wearing a wide brimmed hat and a good quality sunblock. If you have had treatment around the eye area, it is advisable to wear sunglasses when outside.

How does a Skin Resurfacing procedure cost?

Obagi Chemical Peel: £750 – £1200 depending on the area treated.

Dermabrasion: £1,760 – £2,925 depending on the area treated.

Pre-treatment: £150 – £350.

Answers provided by Mr Stephen McCulley and his expert team. You can see further helpful information in our Resource Centre or in our Ask Our Specialist Nurse section.

Stephen McCulley offers a wide range of procedures for skin including removal of moles/cysts, treatment for skin cancer, scar revision and more!

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