Dermatologic Surgery

A skin biopsy is the removal of a skin tissue sample under local anaesthesia for diagnostic purposes. The sample is sent to a histopathologist and, depending on the skin condition, immunohistochemistry, immunofluorescence or molecular testing may also be performed on the material.

It can be performed as:

• Excisional biopsy: classic surgery in which the entire skin lesion, together with a margin of surrounding healthy tissue, is removed with a scalpel in a spindle-shaped excision and the wound is closed with sutures.
• Shave biopsy: a superficial horizontal excision in which part of the lesion is removed with a scalpel, parallel to the skin surface, from the upper layers of the skin (epidermis and part of the dermis). The lesion is not removed in its entirety and sutures are usually not needed afterwards.
• Punch biopsy: using a special round blade of 2.5–5 mm, a cylindrical section of skin is removed, including the deeper layers, and the wound is closed with sutures.

Minor surgical procedures are performed for the removal of moles, cysts, skin nodules and skin carcinomas.

The area of excision is first marked and local anaesthesia is then administered. Skin tissue is removed beyond the borders of the lesion to healthy margins, and the wound is sutured in a way that ensures the best cosmetic result. The procedures are relatively short, depending on the lesion.

Before the procedure, a pre-operative assessment is carried out, including a detailed medical history. Medications such as aspirin and anticoagulants may need to be stopped a few days before the procedure, always in consultation with the treating physician. On the day of the procedure the patient may take their medication and should not consume alcohol. In some cases antibiotic and anti-inflammatory treatment may be needed before the day of surgery.

After the procedure, once the anaesthesia wears off, there is usually no pain, only a pulling sensation in the area. Post-operatively the doctor will give you the necessary instructions for wound care, as well as for when the sutures will be removed.

Cryosurgery is the use of liquid nitrogen, applied through special devices, to treat skin lesions. Thanks to its very low temperature (-196 °C), it allows rapid, targeted freezing of skin tissue and its controlled destruction. It is an alternative to surgical treatment of skin lesions, especially in locations that are difficult to access. It is frequently used to treat actinic keratoses, non-melanoma skin cancers, warts, genital warts, seborrhoeic keratoses, pyogenic granulomas, keloids and more.

The method is easy to apply, with simple aftercare and relatively few side effects. The treated area is frozen and then gradually thaws; during this cycle the cells of the lesion are destroyed. Over the following days a thin crust forms, which falls off and gives way to new, healthy skin. Treatment is completed over a number of sessions at the practice, with excellent cosmetic results.

The doctor has extensive experience and uses both the contact technique (for very sensitive areas) and the spray technique, one of the most common cryosurgery methods. This procedure uses a portable liquid nitrogen spray unit with an adjustable nozzle that varies the spray output, freezing duration and number of application cycles.

Also known as diathermy or electrocautery. It involves the use of a metal tip which, through an electric circuit, develops a high temperature, resulting in local thermal destruction of skin tissue with a simultaneous haemostatic effect. It is used to cauterise papillomas, genital warts and seborrhoeic keratoses, and during surgical procedures.

The procedure can be performed without hospitalisation, under local anaesthesia. During treatment the patient may feel pressure, but usually no pain. Since electrosurgery has potential adverse effects (e.g. burns, interaction with other electrical devices), the procedure should only be performed by a doctor who has received special training in this field and who is familiar with the techniques used to avoid burns.

The CO2 laser is an intense beam of light that vaporises the water in and around skin cells, in many cases replacing conventional surgical removal with a scalpel. The laser causes ablation of these tissues and thus helps treat skin lesions.

Its advantage over surgical excision is the precision with which it removes the lesion — without affecting the adjacent healthy skin, bloodlessly, and without leaving marks or scars.

During the procedure local anaesthesia is used and the lesion is ablated gradually until it is completely removed. If a biopsy is needed, the whole lesion is not ablated immediately; a part of it is first removed and sent for histopathological examination.

After the procedure a crust forms at the site of the lesion, which falls off on its own after a short period. For faster, optimal healing, the use of regenerating/healing creams is recommended once the crust has fallen off.

The EdgeONE CO2 fractional laser used at the practice is the latest innovation of Jeisys, Korea’s largest company and one of the largest worldwide in the field of aesthetic medicine. The EdgeONE offers unmatched precision as a surgical tool and the ultimate experience as an instrument of advanced aesthetic medicine. It has established itself as the “Global Gold Standard” in its class thanks to its proven, technologically unmatched features and its excellent build quality — a status confirmed in the most indisputable way by the American Food and Drug Administration (FDA), which granted it its globally recognised clearance.

The doctor is a certified Laser Safety Officer (LSO), accredited by the University of Aachen, and with the CO2 laser she can operate in:

Surgical Mode

Treatment of conditions such as:

• Papillomas (skin tags)
• Seborrhoeic keratoses
• Warts
• Genital warts
• Freckles
• Solar lentigines
• Xanthelasmas
• Syringomas
• Sebaceous hyperplasias
• Angiofibromas
• Neurofibromas
• Keloids

and many other conditions, once a clear diagnosis of the skin lesion has first been established.

Fractional Mode

For the treatment of:

• Acne marks
• Wrinkles
• Scars
• Reduction of enlarged pores
• Old burns
• Diffuse pigmentation
• Skin tightening
• Post-traumatic and post-surgical scars (hypertrophic – atrophic)
• Stretch marks (red and white)
• Aged and tired skin (resurfacing – rejuvenation)

PlexR® is a new medical device with unique properties, based on the generation of plasma.

With PlexR® we selectively raise the temperature in a specific area and, using a small electric arc resembling “lightning”, we sublimate the superficial skin tissue in the problem areas without affecting the deeper skin layers. This is achieved because the PlexR® device ionises the air particles between its tip and the skin, producing plasma which then ablates the tissue in a fully controlled way — and without generating heat. The overall effect is an immediately visible tightening and rejuvenation of the skin. Because the procedure is highly targeted there is no bleeding and, most importantly, no necrosis of the underlying tissue. Unlike the lasers used in aesthetic medicine today, no protective goggles or other special precautions are required. The PlexR® technique is completely safe, relatively painless (only an anaesthetic cream applied to the skin beforehand is required) and very affordable. No recovery time is needed, as there is no pain or swelling, and return to work or social activities is immediate — make-up can be applied right away.

PlexR® is currently a global pioneer in bloodless aesthetic surgical medicine, also known as Soft Surgery. The list of indications is extremely long.

It is used for non-surgical blepharoplasty and mini face lifting. With PlexR we also treat bags under the lower eyelid, stretch marks — even old ones — and skin laxity in the abdomen, upper arms and inner thighs.

We can correct:

• Acne scars and post-surgical scars
• Age spots
• Benign guttate hypopigmentation of the shins

It also gives very good results in labiaplasty and in the treatment of phimosis.

It is a particularly effective method for the removal of:

• Sebaceous cysts
• Xanthelasmas
• Hyperkeratoses
• Papillomas

The list keeps growing, as new studies on its effectiveness in new indications are constantly emerging.