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Ask a Surgical Dermatologist: Postoperative Considerations after Dermatologic Surgery

by Joel B. Herron, MD

Rates of complications from dermatologic surgery tend to be rare and mild. That said, any complications following surgery can interrupt and interfere with a patient’s quality of life, and there are simple ways to manage most dermatologic surgery complications. As a surgical dermatologist, I’m happy to share my suggested management of these conditions with you.

Common Issues Following Dermatologic Surgery

The most common issues after any dermatologic surgery include bleeding, swelling, bruising, pain, and scarring. Let’s consider each independently.

How to Handle Bleeding After Dermatologic Surgery

Any time the skin is cut, there is the potential for bleeding. During surgery, we mix medications into the numbing agent that help to constrict the blood vessels and reduce the chances of bleeding. However, as these medications wear off, sometimes bleeding can occur. 

Generally, we’ll apply a pressure dressing in the office before you go home. The odds of bleeding through the bandage are very low, but if this does happen, the first step would be to apply ice and firm pressure to the area for approximately 20 minutes. If the bleeding continues, we offer a product called Wound Seal. This product is a powder, very much like sand, that has been used for people with clotting disorders or on blood thinners. To apply, you’ll remove your bandage, pour the powder directly into the wound, and apply pressure for approximately two minutes. This will form a scab to stop the bleeding.

How to Manage Bruising and Swelling After Dermatologic Surgery

Bruising and swelling are common, and should be expected after any surgery. These conditions can be reduced with intermittent ice applications applied using a cloth or similar material so that the skin itself does not get too cold and suffer from cold-induced injury. Apply the ice for several minutes and then take a break. This can be applied and repeated several times for the first day or two after a procedure. The application of ice may also help with any pain or discomfort after the procedure.

What to Do About Pain After Dermatologic Surgery

Some degree of pain or discomfort can be expected after any surgery, but most dermatologic surgical procedures result in very mild discomfort. Dermatologic surgery is usually confined to the skin and does not involve the muscle, which usually means less pain. When muscles are involved, and you move in a way that utilizes the involved muscle (coughing, sneezing, etc.), that can cause substantial discomfort right after surgery. 

If you experience pain or discomfort, studies show that combining Tylenol and ibuprofen provide superior pain relief to opioid medications.

Patients may take a maximum of 3000 mg per day of Tylenol and 3200 mg per day of ibuprofen, and we recommend taking 1000 mg of Tylenol and up to 800 mg of ibuprofen every eight hours. These medications may be taken together at the same time, or staggered so that you’re taking something every four hours for pain relief. Utilization of these medications together provides greater pain relief than narcotics without the potential for addiction or the nasty side effects of opioid medications. That said, patients should not have any underlying medical conditions that would prohibit them from taking acetaminophen or ibuprofen. These might involve conditions affecting the liver or kidney. If this combination of medications does not provide adequate pain relief, one of our staff is always available on call and may be able to phone in a prescription pain medication.

How to Reduce Scarring After Dermatologic Surgery

Any time the skin is cut, there will be a resultant scar. My intent and hope is that we will be able to minimize the appearance of any scarring, but the final result of a scar is determined not just by the procedure performed, but by your own tendency towards healing. Some patients heal better, faster, and with less conspicuous scarring than others.  

To improve a scar’s final appearance and speed the healing process, we suggest that you wash the area with soap and water and apply an ointment such as Polysporin or Vaseline in order to keep the wound moist while sutures are in. We also recommend the use of an over-the-counter scar gel containing silicone beginning several days after a procedure. Silicone is an ingredient that has been shown to help soften and flatten a scar as well as help reduce the chances of forming keloids, which are the thickened and raised scars that can form after surgery. Though silicone can help, you should be aware that there is sometimes a genetic predisposition towards keloids, and that certain anatomic locations of the body are more prone to keloids, including the shoulders, upper back, and upper chest. The silicone scar gel can be applied as a small dab and gently massaged into the area for approximately one minute once or twice a day, and this can be continued until the scar is soft, flat, and smooth.  While most scars will become cosmetically less apparent within several weeks to several months, a scar will continue to remodel and improve for a period of up to 18 months.

Any time you’re in our office for a procedure, our staff will review these instructions with you and provide you with written guidelines and reminders after your procedure. Please don’t hesitate to get in touch with questions!