Moles, or nevi, are clustered skin growths that can occur almost anywhere on your body and are frequently encountered on the face and neck. They are usually pigmented – either brown or black in color – but can also be somewhat clear – or similar to the surrounding skin color. Facial moles are usually noted during early childhood, although some may not appear until decades later.
Unfortunately, a good number of moles in the facial region are considered cosmetically undesirable. I happen to consult with quite a few patients on a very regular basis who desire to have these type of facial moles removed.
- Mole Shaving Versus Excision
- Mole Removal Recovery
- Scarring and Mole Removal
- Cost of Mole Removal
- Facial Mole Shave Removal
- Facial Mole Excision Removal
Mole Shaving Versus Excision
Depending on the features of an individual mole, I will likely recommend either shaving or excision. Both of these are considered surgical procedures in that a scalpel is involved in one way or another. They are also both done using just local anesthesia – like going to the dentist where the numbing medicine is injected directly under the targeted facial mole.
Shaving a facial mole implies that a scalpel is used to cut under the base of the mole in parallel with the skin surface. As the scalpel is passed entirely under the mole, it is essentially shaved off the surface of the skin. However, most facial moles have microscopic cells (you cannot see them with the naked eye) that extend below the immediate surface of the skin. If these cells are left alone and remain in the skin, they will increase the likelihood the mole will simply grow back in the future – referred to as recurrence of the mole. Therefore, I will usually perform additional dermabrasion of the skin surface immediately after shaving a mole. In some cases, I will also perform electrocautery of the skin (where the mole was attached). Both of these are done in an attempt to remove those microscopic cells that would, otherwise, remain in the superficial layer of the skin.
Excision of a mole also involves use of scalpel; however, in this instance it is used to cut down into the skin. The most common excision method involves making a cut around the mole that is in the shape of an ellipse, or a football. Instead of cutting along the superficial surface of the skin, excision of a mole involves making a deeper cut into what is called the dermal layer (or dermis) of the skin. The entire ellipse of skin is then removed – along with the attached, overlying mole. As you can imagine, there is a fairly visible defect in the skin in the shape of the ellipse that was just excised. In order to close this defect, the skin edges need to be brought together. In the world of plastic surgery, the most important part of bringing skin edges together is the deeper tissue. This involves very careful, meticulous placement of hidden sutures (stitches) underneath the superficial skin layer. If done properly, these deeper sutures will actually intentionally create a visible bump or ridge along the skin surface. This is referred to as ‘eversion’ in plastic surgery jargon. Once this is accomplished, the actual skin edges are then brought together using very fine sutures. In some cases these skin sutures are quickly absorbed while in others they are non-absorbable and removed in 5-6 days after the procedure. The end result is usually a fairly straight line (or linear) scar where the mole previously existed (see adjacent diagram). Keep in mind this linear scar is actually wider than the width of the mole. This is because the elliptical excision pattern requires us to taper both ends in order to allow optimal closure of the skin – thus we have to make the cut longer than the width of the mole. Ultimately, you will have replaced an unsightly mole with a scar that is hopefully less visible and distracting.
Mole Removal Recovery
Recovery from facial mole shaving takes an initial 5-6 day period of healing. During this time, it is advised that you do not allow any scabbing or crusting of the site. Keeping the area clean and applying ointment on a regular basis will help in this process. By the end of the first week, most patients feel quite comfortable back in the public eye after facial mole shaving. As time goes on, the skin begins to assume a more normal color and texture to the point where it is oftentimes very difficult to see where the mole shaving occurred.
Recovery from facial mole excision takes longer than mole shaving. This is directly related to the fact the dermal layer of the skin has been cut into during the procedure. Consequently, an entire cascade of collagen deposition and healing is triggered with facial mole excision that is not seen with shaving. That being said, most patients are still quite comfortable in the public eye 5-6 days after facial mole excision. At that time, the non-absorbable sutures (if used) are removed from the skin surface. In most cases, the skin will continue to have a slight ridged appearance until this settles down during the first 1-2 months. The scar will take upwards of one year to fully evolve in terms of its final appearance.
Scarring and Mole Removal
There is much less likelihood you will notice scarring following facial mole shaving since the scalpel does not necessarily go into the dermal layer of the skin. It doesn’t mean there will be absolutely no scarring from facial mole shaving – it just means there is significantly less chance of it occurring with this technique of facial mole removal.
With facial mole excision, there is no doubt about it – you will have a scar. As noted earlier – you are effectively replacing the mole with a scar. Fortunately, in a great majority of facial mole excisions, the final appearance of the scar is quite acceptable – especially when comparing it to the appearance of the original mole. In a great number of cases, I also try to hide the scar in a natural skin crease – making the final appearance even less noticeable. Unfortunately, there is still a small percentage of patients who will develop suboptimal healing of the tissue – leading to a scar that is more visible than desired. If this does occur, it may prompt additional surgery in the form of scar revision to help make the scar much more pleasing.
With both shave and excision of a facial mole, there is also a chance of hypopigmentation of a scar where the color of the skin turns much lighter than the surrounding area. There is also a risk of hyper pigmentation where the skin turns darker than the surrounding area. Fortunately, the likelihood of hypopigmentation and hyperpigmentation are quite low overall.
There is usually a higher chance of recurrence with shaving of a facial mole compared to the excision technique. In cases where the mole returns following shaving, a simple repeat shaving procedure is typically sufficient in getting rid of the mole once and for all. In those extreme cases where the mole recurs even after subsequent shaving, it is usually my recommendation that mole excision be used as a next step.
Cost of Mole Removal
Because facial mole shaving is not as involved, the cost for this type of procedure are much less relative to facial mole excision. This also takes into account the fact that facial mole excision requires much more finesse and surgical technique – as well as a much longer follow-up period to help ensure that optimal healing takes place.
In some cases where multiple facial moles are being shaved off and/or excised, we do offer a discount if they are taken off all at the same time.
Facial Mole Shave Removal
Here is an example of a patient who desired to have shaving of a couple facial moles involving her right cheek region. Her moles were moderately dark and only slightly raised off the skin surface. Given the delicate area where they were located, I did not think that cutting them out (excision) was in her best interest. I, instead, performed shaving of both facial moles using the exact technique described previously. As you can see in her ‘after facial mole shaving’ photo, there is very little evidence the moles were ever there – and even more importantly, no evidence that I was ever there!
Facial Mole Excision Removal
This is an example of a patient who elected to have a facial mole excised, or cut out. This was a rather bothersome mole involving her left cheek region. We discussed the various options in terms of removal – including a discussion of possible recurrence and scarring. She ultimately elected to undergo excision of the mole. This was done with the precise technique described above to achieve the results seen here. As you can easily appreciate, the mole is now completely gone from her left cheek. And if you look fairly closely, you will note that her scar is very acceptable – minimal in appearance without any obvious signs of distortion to the surrounding skin. The patient was quite happy with the result – as most patients are following facial mole excision performed in my office.
If you have a facial mole (or several facial moles) that are cosmetically bothersome and you are looking to get them removed, contact our office today to schedule an individual consultation with our facial plastic surgeon, Dr. John Hilinski.