Cosmetic Indications

Dr. Hilinski offers mole removal for cosmetic indications – not for medical purposes of treating, for instance, a skin cancer. If there is any significant concern that a mole has become something more than just a cosmetic issue – specifically, if there is a concern for skin cancer – then you should consult with a dermatologist and not Dr. Hilinski.

Overall Management Options

When it comes down to management of a mole, there are really 4 main options available to you.

1. Do nothing – since it is a cosmetic concern only, you can simply do nothing and leave the mole alone (we call this observation)
2. Laser mole treatment
3. Mole shave
4. Mole excision – also referred to as ‘cutting a mole out’ of the skin

The three treatment options (laser, shave and excision) are all typically done using just local anesthesia – like going to the dentist where numbing medicine is injected directly under the targeted mole so you don’t feel any pain. Now the injection of the numbing medicine does hurt – like a sharp pinch and burning sensation – but only for a few seconds before the area goes completely numb and the procedure can be done.

Laser Mole Treatment

Lasering a mole involves use of our Lumenis CO2 laser to vaporize the mole away. In today’s day and age of advanced technology, sometimes using the laser can provide you and Dr. Hilinski a huge advantage when it comes to mole removal. Specialized settings are chosen that allow the laser to be used to ‘burn’ the mole. This is usually done in a sequential manner – meaning the mole is treated with the laser by going over it several times until the mole is no longer visible to the naked eye. One of the big benefits of using a laser to get rid of a mole is that the heat given off by the laser beam can be beneficial in eradicating the invisible, microscopic cells that are contained in the base of the mole. By treating these cells that you cannot see, there is usually a lower likelihood of recurrence of the mole.

Laser Mole Removal

Here is a short video demonstrating visually how the Lumenis CO2 laser can be used to remove this large mole from this female patient’s face. If you look closely, you will see a red beam of light – which is the aiming beam for the laser. As the laser is activated, you can see the mole change in color – become a chalky white color as the laser is passed over the mole. The laser is used to gradually vaporize the entire mole until it has been taken down to the level of the surrounding skin surface. As you can readily appreciate in her before and after photos shown in the video, the laser can be a very powerful tool in helping to get rid of unwanted moles with minimal scarring.

Plasma Pen Mole Removal

Plasma pen mole removal is very similar to the laser mole treatment noted above. In fact, it is essentially the same technique, except a plasma pen device is utilized instead of the laser. Plasma pen treatment for moles is based on generation of plasma energy at the surface of the mole and surrounding skin. As the plasma pen device is carefully brought closer to the mole the heat energy allows for vaporization of the mole tissue. This can be done sequentially just like when using the CO2 laser to reduce the visibility of the mole. Like any of the mole removal techniques mentioned here, there is always the chance the mole may return, there may be residual regrowth of the mole and that unwanted scarring may occur (including discoloration of the treatment area and surrounding skin.

Here is a great example of how our plasma pen is used for mole removal. This young lady was bothered by a brown, raised mole – the most common type we see in our office – along the tragus of her ear. You can see the mole very readily in the adjacent photo series shown here. In the middle photo you can see the bright ‘spark’ of the plasma pen as it is used to sequentially vaporize the mole tissue. The really cool thing here is that the tip of the pen is not even contacting the mole. There is actually a gap between the surface of the mole and the plasma pen. The nitrogen air in the room is being used as it is electrified – creating the desired plasma energy, which in turn is used to get rid of the mole. This particular procedure took about 5-10 minutes in total and was done using just a tiny bit of local anesthesia injected into the mole. Months later she was back for a check up and you can see the mole is no longer visible. You can also see there is no obvious scarring where the mole was removed. Pretty slick, huh? This is why we absolutely love using the plasma pen for mole removal in our office!

Mole Shave

Mole shave 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 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 above as recurrence of the mole. Therefore, Dr. Hilinski will usually perform additional dermabrasion of the skin surface when he shaves a mole. In some cases, Dr. Hilinski will also perform laser or electrocautery of the skin where the mole was previously attached. This additional step is done in an attempt to remove those microscopic cells that would, otherwise, remain in the superficial layer of the skin.

Mole Excision

Mole excision also involves use of scalpel; however, with mole excision, the scalpel is used to actually cut down into the skin. The most common mole excision method involves making a cut around the mole that is in the shape of an ellipse, or a football. Unlike mole shaving, 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 create an intentional, 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. Keep in mind this linear scar is actually wider than the width of the mole. Yes – the scar is wider than the mole! This is because the elliptical excision pattern requires Dr. Hilinski to taper both ends in order to allow optimal closure of the skin – thus making the cut longer than the width of the mole. In an ideal world, the resulting scar will fade over time. BUT THERE WILL ALWAYS BE A SCAR WHERE THE MOLE ONCE WAS LOCATED. Ultimately, think of it as replacing an unsightly mole with a scar that is hopefully less visible and distracting.

Flat Versus Raised

In general, flat moles typically require an excision technique in order for them to be removed. That is because laser and shave techniques are usually not recommended when the mole is totally embedded within the skin. Raised moles are generally treated with laser, shave or excision technique.

Mole Removal Recovery

Recovery from mole removal 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 removal. As time goes on, the skin begins to assume a more normal color and texture to the point where it is often times very difficult to see signs of having had a mole removed.

If you elected to have the mole excised, or cut out and sutured, recovery can be longer. 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 mole excision that is not necessarily seen with laser and shave techniques. 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

It should be noted by anyone considering mole removal – IT IS NOT POSSIBLE TO HAVE A MOLE REMOVED WITHOUT SOME DEGREE OF SCARRING. If it is your belief and/or expectation that this can be done without scarring – please do NOT schedule an appointment with Dr. Hilinski.

With laser and shave technique, there is much less likelihood of having a really visible scar – but it is NOT zero. There is still a chance you will have a scar that may be quite visible even with mole laser and shave.

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, Dr. Hilinski will also try to hide the scar in a natural skin crease – making the final appearance even less noticeable. Unfortunately, despite meticulous technique and care, 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. Can the scar be even more unsightly than the mole – it can in some cases. If this does occur, it may prompt additional surgery in the form of scar revision to help make the scar more pleasing in terms of its appearance.

With any of these techniques for mole removal, 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 hyperpigmentation where the skin turns darker than the surrounding area. Fortunately, the likelihood of hypopigmentation and hyperpigmentation are quite low overall.

Mole Recurrence

There is usually a higher chance of recurrence with mole laser and shave techniques when compared to the excision technique. In cases where the mole returns following laser and shave, a repeat 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 treatment, it is usually recommended that mole excision be used as a next step.

Summary

Here is a summary table regarding the various options when it comes to management of a facial mole.

Cost of Mole Removal

Because facial mole laser and shave is technically easier to do, the cost for this type of procedure is less relative to facial mole excision.

On average, mole laser and shave start around $400 per mole. For mole excision, it can be considerably more depending on the size and location of the mole. Can you get your mole removed for cheaper? Absolutely. If you search online, you will find that many doctors will remove your mole for much less money. The reality is that Dr. Hilinski charges a premium because of his credentials and advanced training and experience.

If you have multiple moles that you desire to get treated, there may be a discount applied for doing all of them at one time.

THERE IS NO WARRANTY OR GUARANTEE THAT ANY MOLE WILL BE GONE FOREVER – REGARDLESS OF THE CHOSEN TECHNIQUE. THEREFORE, BE PREPARED TO PAY AN ADDITIONAL FEE IF YOU HAVE TO UNDERGO MORE THAN ONE PROCEDURE.