Plastic surgery restores form and function through reconstructive procedures, cosmetic enhancements, and body contouring.
Send us all your questions or requests, and our expert team will assist you.
Serial excision allows for the removal of a nevus in stages without the need for complex tissue flaps or grafts. The surgeon removes the central portion of the nevus and sutures the edges of the normal skin together. This places tension on the skin, which stimulates it to stretch over time.
After several months of healing, the skin relaxes. The patient returns for a second procedure in which more of the nevus is removed, and the skin is advanced further. This cycle repeats until the entire lesion is gone, leaving a single linear scar.
Tissue expansion is the workhorse for giant nevus reconstruction. A silicone expander is surgically placed under the normal skin adjacent to the nevus. Over a period of weeks, saline is injected into the expander through a port, gradually stretching the skin.
This process induces biological skin growth, increasing the surface area of healthy skin with matching color and texture. Once adequate skin is generated, a second surgery is performed to remove the expander, excise the nevus, and cover the defect with the new skin.
When local tissue is insufficient or expansion is not feasible, full-thickness skin grafts are used. This involves taking the entire epidermis and dermis from a donor site (often the groin or abdomen) and stitching it over the wound where the nevus was removed.
Full-thickness grafts contract less than thinner grafts and provide better texture and color matches. They are ideal for areas such as the eyelids, nose, or hands, where thin, pliable skin is necessary for function.
For vast areas, full-thickness and split-thickness are available. These grusedlude only affect the epidermis and a portion of the dermis. The donor site heals on its own, similar to a deep scrape.
While these grafts help cover significant defects, they are prone to contraction and pigmentary changes. They often have a different texture than the surrounding skin and may require future laser treatments to improve their appearance.
Local flaps involve lifting adjacent healthy skin and rotating or advancing it to cover the defect. Unlike grafts, flaps maintain their own blood supply, resulting in robust healing and better aesthetic outcomes.
Standard flap designs include rotation flaps, transposition flaps, and advancement flaps. These are particularly useful for facial nevi where preserving the contour and color match is critical for aesthetic harmony.
Dermabrasion is a technique sometimes used in the first few weeks of life. It involves mechanically removing the upper layers of the skin where the majority of the pigment cells reside. This takes advantage of the unique healing properties of neonatal skin.
This procedure must be performed very early to be effective. It does not remove the deep component of the nevus, so there is a risk of repigmentation. It is often used to lighten the lesion and improve texture rather than for complete removal.
Similar to dermabrasion, curettage involves scraping the nevus cells from the dermis. This is performed in the first two weeks of life when a natural cleavage plane exists between the upper and lower dermis.
This technique can significantly reduce the pigment and thickness of the nevus with minimal scarring. However, like dermabrasion, it is not a complete excision, and long-term surveillance for repigmentation and malignancy is still required.
Laser therapy is rarely used as a primary removal method for congenital nevi due to the depth of the cells. However, it serves as an excellent adjunct. Lasers can be used to treat repigmentation (recurrence) after surgery or to improve scar texture.
Pigment-specific lasers target melanin, while fractional resurfacing lasers improve the texture and pliability of skin grafts or surgical scars. This helps to blend the reconstructed area with the surrounding normal skin.
Integra is a bioengineered tissue scaffold used when there is not enough native skin to cover a defect. It consists of a collagen layer that mimics the dermis. It is placed over the wound after nevus excision.
The patient’s own cells migrate into this scaffold, creating a new dermal layer. Once this layer is vascularized (usually a few weeks later), a thin skin graft is applied. This results in more pliable, cosmetically superior skin than a graft alone can provide.
Reconstructing the scalp presents the unique challenge of preserving the hairline. Tissue expansion is particularly effective here. Expanders are placed under the hair-bearing scalp to stretch it.
This expanded scalp is then advanced to cover the area where the nevus was removed. This brings hair-bearing skin into the defect, minimizing bald spots and restoring a natural hairline appearance.
Nevi on the eyelids require specialized techniques to prevent distortion of the eye shape (ectropion). Full-thickness skin grafts are often used here because they are thin and contract minimally.
The surgery must carefully preserve the eyelid’s function to ensure the eye can close completely and protect the cornea. Cosmetic outcomes are balanced with the vital need for ocular protection.
Giant nevi on the arms or legs can sometimes restrict movement if the skin is tight or scarred. Removal and reconstruction must prioritize range of motion. Z-plasties (scar-rearranging techniques) are often used to break up linear scars across joints.
If a nevus encompasses the entire circumference of a limb, staged excision is planned to avoid constructing a tourniquet-like scar band that could impede lymphatic drainage or blood flow.
Send us all your questions or requests, and our expert team will assist you.
A skin graft involves completely detaching skin from one area and moving it to another; it relies on the new bed for blood supply. A flap involves moving skin that remains attached to its original blood supply, leading to more robust healing and better cosmetic results.
The placement surgery is uncomfortable, similar to other surgeries. The weekly injections to fill the expander cause a feeling of pressure and tightness that typically lasts a few hours. Most children tolerate the process surprisingly well.
The expansion process usually takes 3 to 4 months. This includes the surgery to place the device, the weeks of gradual inflation, and the final surgery to remove the device and the nevus.
Lasers can only penetrate the skin’s surface layers. Congenital nevi have cells deep in the fat and fascia. Lasers cannot reach these deep cells without causing massive scarring, and leaving deep cells behind leaves the melanoma risk intact.
Meshing involves cutting small slits in a skin graft so it can stretch to cover a larger area. While functional, this leaves a “waffle” pattern scar. In cosmetic reconstruction for nevi, surgeons try to avoid meshing whenever possible to ensure a smooth appearance.
Your Comparison List (you must select at least 2 packages)
