Dermatosurgery

Specialized Surgical Treatment for Skin, Hair and Nail Conditions

Dermatosurgery is a specialized field of dermatology involving the diagnosis and surgical treatment of skin, hair, nail and soft-tissue conditions. It includes minor office-based procedures, skin biopsies, removal of benign and suspicious growths, nail surgery, scar revision, vitiligo surgery and selected reconstructive procedures.

At Skin Life Clinic, dermatosurgical procedures are planned and performed under the supervision of Dr. Tahir Kamal, Consultant Dermatologist, Dermatosurgeon and Reconstructive Aesthetic Surgeon.

Our approach emphasizes accurate diagnosis, complete treatment, careful wound closure, preservation of healthy tissue and the best realistically achievable cosmetic outcome.

Conditions Treated with Dermatosurgery

Dermatosurgical procedures may be used to diagnose or treat:

• Moles and pigmented lesions

• Skin tags

• Cysts

• Lipomas

• Warts

• Seborrhoeic keratoses

• Dermatofibromas

• Syringomas and other benign growths

• Suspicious or cancerous skin lesions

• Chronic wounds and non-healing ulcers

• Ingrown toenails

• Nail tumours and unexplained nail pigmentation

• Keloids and hypertrophic scars

• Acne and traumatic scars

• Stable vitiligo

• Burn scars and contractures

• Selected hair and scalp disorders

• Localized excessive sweating

• Selected vascular or soft-tissue lesions

Not every growth should be removed purely for cosmetic reasons. An examination is necessary to confirm the likely diagnosis and determine whether histopathological assessment is required.

Skin Biopsy

A skin biopsy involves removing a small sample of skin for microscopic examination. It is one of the most important diagnostic procedures in dermatology.

A biopsy may be recommended for:

• An unexplained persistent rash

• A changing or suspicious mole

• A non-healing ulcer

• Autoimmune blistering disease

• Connective-tissue disease

• Vasculitis

• Unexplained pigmentation

• Hair loss suggesting scarring alopecia

• A suspected infection

• A possible skin tumour

• A condition that has not responded to treatment

Types of Skin Biopsy

Depending on the condition, the dermatologist may perform:

• Punch biopsy

• Shave biopsy

• Incisional biopsy

• Excisional biopsy

• Scalp biopsy

• Nail-unit biopsy

• Mucosal biopsy

The site and biopsy type are selected to obtain the most useful diagnostic tissue while minimizing unnecessary scarring.

Histopathological Examination

Tissue removed during biopsy or surgery may be sent to a laboratory for histopathological examination.

The report may help determine:

• The exact diagnosis

• Whether a growth is benign or malignant

• Whether a lesion has been completely removed

• The type and depth of a skin tumour

• The presence of inflammation, infection or autoimmune disease

• Whether further treatment is necessary

Patients should attend the recommended follow-up appointment to discuss the report. A wound appearing healed does not remove the need to review the histopathology result.

Removal of Moles and Skin Growths

Moles and other growths may be removed because they are:

• Clinically suspicious

• Changing in size, shape or colour

• Repeatedly irritated or injured

• Bleeding

• Painful or inflamed

• Affecting function

• Causing significant cosmetic concern

Removal methods may include:

• Surgical excision

• Shave removal

• Punch excision

• Electrosurgery

• Radiofrequency surgery

• Cryotherapy

• Laser treatment for carefully selected benign lesions

Suspicious pigmented lesions should not be destroyed without establishing an appropriate diagnosis. Surgical removal with histopathological examination may be safer when malignancy is a concern.

Skin-Cancer Surgery

Skin cancers and precancerous lesions require timely diagnosis and appropriate treatment.

Conditions may include:

• Basal cell carcinoma

• Squamous cell carcinoma

• Melanoma

• Actinic keratosis

• Bowen disease

• Keratoacanthoma

• Other uncommon skin tumours

Treatment planning depends on:

• Type of tumour

• Size and depth

• Anatomical location

• Histopathology findings

• Patient’s age and health

• Risk of recurrence

• Need to preserve function and appearance

Surgical excision is commonly used. More complex or high-risk cases may require wider surgery, specialist cancer services or multidisciplinary management.

Cyst Removal

Epidermoid and other benign cysts may present as slowly enlarging lumps under the skin. They may occasionally become painful, inflamed or infected.

Treatment options depend on the condition of the cyst:

• Observation

• Intralesional treatment for selected inflammation

• Drainage when acutely infected

• Antibiotic treatment when clinically indicated

• Complete surgical excision after inflammation settles

Removing the cyst wall helps reduce recurrence. Excision during severe acute inflammation may be less suitable in some cases.

Lipoma Removal

A lipoma is a soft, usually benign fatty lump beneath the skin.

Removal may be considered when it is:

• Increasing in size

• Painful

• Repeatedly irritated

• Affecting movement

• Causing cosmetic concern

• Clinically uncertain

An unusually firm, rapidly growing, deep or painful lump may require imaging or further investigation before surgery.

Wart Surgery

Warts are caused by human papillomavirus and may occur on the hands, feet, face, genital area or other sites.

Treatment may include:

• Cryotherapy

• Electrosurgery

• Radiofrequency treatment

• Curettage

• Laser treatment

• Topical or injectable medical treatment

• Surgical removal in selected cases

Warts may recur because treatment removes visible lesions but may not completely eliminate the virus from surrounding skin.

Electrosurgery and Radiofrequency Surgery

Electrosurgery and radiofrequency techniques use controlled electrical energy to cut tissue or achieve haemostasis.

They may be used for selected:

• Skin tags

• Warts

• Seborrhoeic keratoses

• Small benign growths

• Certain vascular lesions

• Raised scars

• Superficial skin lesions

The likely diagnosis should be established before destructive treatment. Local anaesthesia is generally used where required.

Cryosurgery

Cryosurgery uses very low temperatures, commonly liquid nitrogen, to destroy selected abnormal tissue.

It may be used for:

• Common warts

• Seborrhoeic keratoses

• Actinic keratoses

• Selected superficial lesions

• Certain precancerous changes

Temporary blistering, crusting, swelling or colour change can occur. Darker skin types may have a greater risk of post-treatment pigmentation changes.

Nail Surgery

Nail surgery may be required for painful, recurrent or diagnostically uncertain nail conditions.

Procedures may include:

• Partial nail removal

• Total nail-plate removal

• Chemical or surgical matrix treatment

• Treatment of ingrown toenails

• Drainage of infection

• Nail-bed repair

• Nail-unit biopsy

• Removal of selected nail growths

• Assessment of suspicious nail pigmentation

Ingrown Toenail Surgery

An ingrown toenail occurs when the nail edge penetrates the surrounding skin, causing pain, swelling, infection or excessive tissue growth.

For recurrent cases, treatment may involve removal of the affected nail edge and controlled treatment of the corresponding nail-producing matrix. This can reduce the risk of recurrence while preserving most of the nail.

Scar Revision

Scars may develop after acne, injury, burns, surgery or infection. Treatment depends on whether the scar is raised, depressed, widened, contracted, pigmented or red.

Options may include:

• Surgical scar revision

• Subcision

• Intralesional injections

• Silicone therapy

• Pressure treatment

• Microneedling

• Fractional laser resurfacing

• Radiofrequency microneedling

• Dermal filler for selected depressed scars

• Platelet-based procedures

• Combination treatment

Scar treatment aims to improve appearance, texture, flexibility or symptoms. No procedure can completely erase a scar.

Keloid and Hypertrophic-Scar Treatment

Keloids and hypertrophic scars result from excessive scar-tissue formation.

Treatment may include:

• Intralesional corticosteroid injections

• Combination injections

• Silicone gel or sheets

• Pressure therapy

• Cryotherapy

• Laser treatment

• Surgical removal in carefully selected cases

• Combination treatment to reduce recurrence

Surgery alone may allow a keloid to recur and occasionally become larger. A recurrence-prevention strategy should therefore be planned.

Acne-Scar Surgery

Deep acne scars may require targeted surgical procedures rather than laser treatment alone.

Depending on scar type, treatment may include:

• Subcision for tethered rolling scars

• Punch excision

• Punch elevation

• Chemical reconstruction of ice-pick scars

• Dermal filler

• Fractional resurfacing

• Radiofrequency microneedling

• Platelet-based treatment

Combination treatment is frequently required because different scar types may be present on the same face.

Vitiligo Surgery

Vitiligo surgery may be considered for selected patients with stable localized disease that has not responded adequately to medical treatment.

Procedures may include:

• Mini-punch grafting

• Suction-blister epidermal grafting

• Split-thickness skin grafting

• Melanocyte or cellular transplantation where available

• Needling or other selected techniques

• Phototherapy following surgery

Who May Be Suitable?

The best candidates usually have:

• Stable vitiligo

• No recent development of new patches

• No recent enlargement of existing patches

• No active Koebner phenomenon

• Localized areas resistant to medical treatment

• Realistic expectations regarding repigmentation

Hands, feet, fingers, toes and areas over bony prominences may respond less predictably.

Hair-Transplant Surgery

Hair transplantation is a dermatosurgical procedure in which follicles are moved from a donor area to an area of hair loss.

It may be used for selected:

• Male pattern hair loss

• Female pattern hair loss

• Eyebrow loss

• Beard or moustache gaps

• Stable surgical or traumatic scars

• Stable scarring alopecia

Detailed diagnosis, donor-area assessment and long-term planning are required before surgery.

Earlobe Repair

Split, stretched or enlarged earlobes may result from heavy earrings, trauma or previous piercing.

Repair may involve:

• Freshening the damaged edges

• Reconstructing the natural earlobe contour

• Layered surgical closure

• Re-piercing after complete healing when appropriate

The timing of re-piercing and aftercare should follow medical advice.

Ear and Facial Soft-Tissue Repair

Selected minor injuries or defects involving the face or ear may be repaired using careful tissue handling and reconstructive closure.

Treatment planning aims to:

• Preserve anatomical landmarks

• Restore function

• Reduce wound tension

• Position scars within natural creases where possible

• Achieve the best realistic cosmetic outcome

Complex injuries may require treatment in a hospital or referral to an appropriate surgical specialty.

Burn-Scar and Contracture Management

Burn scars can cause tightness, restricted movement, itching, pain and cosmetic alteration.

Management may involve:

• Scar massage and silicone therapy

• Pressure garments

• Intralesional treatment

• Laser procedures

• Surgical scar release

• Z-plasty

• Local flaps

• Skin grafting

• Referral for physiotherapy

• Multidisciplinary reconstructive care

The treatment plan depends on the scar’s maturity, location, thickness and effect on movement.

Reconstructive Skin Surgery

After removal of a lesion or release of a scar, the wound may require reconstruction.

Closure options may include:

• Direct suturing

• Layered closure

• Local skin flaps

• Advancement or rotation flaps

• Z-plasty

• Skin grafting

• Healing by secondary intention in selected wounds

The technique is chosen according to the defect’s size, depth, location and surrounding skin.

Chronic Wounds and Ulcers

Non-healing wounds require assessment of both the skin and the underlying cause.

Possible contributing factors include:

• Diabetes

• Poor arterial blood flow

• Venous insufficiency

• Pressure

• Neuropathy

• Infection

• Autoimmune disease

• Vasculitis

• Pyoderma gangrenosum

• Skin cancer

• Repeated trauma

Treatment may involve wound care, debridement when appropriate, biopsy, infection control, compression for suitable venous ulcers and referral to other specialists.

Not every ulcer should be surgically debrided. Some inflammatory ulcers can worsen after trauma, making accurate diagnosis essential.

Local Anaesthesia

Many dermatosurgical procedures can be performed under local anaesthesia. The patient remains awake while the treatment area is numbed.

Temporary effects may include:

• Mild stinging during injection

• Numbness

• Temporary swelling

• Minor bruising

• Short-term tenderness after the anaesthetic wears off

Larger or more complex procedures may require hospital-based care or another form of anaesthesia.

Before Your Procedure

Patients should inform the doctor about:

• Current medicines and supplements

• Blood-thinning medicines

• Drug or local-anaesthetic allergies

• Diabetes

• Heart disease

• Bleeding disorders

• Pacemakers or implanted devices

• Previous keloids

• Pregnancy or breastfeeding

• Recent infection

• Previous surgery in the same area

Do not stop prescribed medicine without discussing it with the relevant treating doctor.

Aftercare and Wound Care

Instructions vary according to the procedure but may include:

• Keeping the wound clean and protected

• Changing dressings as advised

• Applying prescribed ointment

• Avoiding unnecessary touching or pressure

• Limiting strenuous activity

• Protecting the healing area from sunlight

• Returning for suture removal

• Attending review of the histopathology report

• Watching for signs of infection

• Following a scar-prevention plan

Patients should contact the clinic if they develop increasing pain, spreading redness, pus, persistent bleeding, fever, wound separation or unusual skin discolouration.

Scarring After Surgery

Every procedure that cuts or removes skin can produce a scar. Its final appearance depends on:

• Size and depth of the procedure

• Anatomical location

• Skin tension

• Patient’s age and skin type

• Individual healing tendency

• Infection or wound complications

• Sun exposure

• Adherence to aftercare

• History of keloid formation

Careful surgical technique can reduce scar visibility but cannot guarantee a scar-free result.

Possible Risks

Risks vary according to the procedure and may include:

• Pain or tenderness

• Bleeding

• Bruising and swelling

• Infection

• Delayed healing

• Wound separation

• Visible scarring

• Keloid formation

• Pigmentation changes

• Numbness or altered sensation

• Damage to nearby structures

• Allergic reaction

• Recurrence of the original condition

• Incomplete removal

• Need for additional surgery

The expected benefits, alternatives and relevant risks are discussed before consent.

Why Choose Skin Life Clinic?

• Assessment by an experienced consultant dermatologist

• More than 30 years of clinical and surgical experience

• Diagnosis before cosmetic or destructive removal

• Expertise in skin biopsy and histopathological correlation

• Treatment of skin, nail, hair and scar conditions

• Experience in vitiligo and hair-restoration surgery

• Careful attention to wound closure and scar placement

• Reconstructive and aesthetic surgical experience

• Appropriate postoperative and pathology follow-up

• Individualized treatment and aftercare planning

About Dr. Tahir Kamal

Dr. Tahir Kamal is a Consultant Dermatologist, Dermatosurgeon, Aesthetic Physician and Reconstructive Aesthetic Surgeon with more than 30 years of experience.

His clinical work includes medical dermatology, skin surgery, laser dermatology, nail surgery, scar revision, hair transplantation, vitiligo surgery and selected reconstructive procedures.

Qualifications and appointments:

• MBBS

• FCPS Dermatology

• D.D.Sc. UK, Gold Medalist

• MAACS USA

• CHPE, Gold Medalist

• Professor and Head of Dermatology, Al-Aleem Medical College and Gulab Devi Teaching Hospital

• CPSP Supervisor for FCPS, MD and MCPS

• CPSP Examiner for FCPS and MCPS

Book a Dermatosurgery Consultation

If you have a changing skin lesion, persistent growth, painful nail condition, troublesome scar or another concern that may require a procedure, arrange an assessment with Dr. Tahir Kamal.

A consultation will help determine the diagnosis, suitable treatment, expected recovery and whether laboratory examination of removed tissue is required.

WhatsApp: +92 333 433 8883
Clinic: Skin Life & Aesthetic Clinic, Lahore

Book an Appointment

Information on this page is provided for general education. Diagnosis, treatment suitability, expected outcomes and surgical risks vary between individuals and require an in-person medical assessment.