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For pre-cancerous lesions (actinic keratoses), Mohs surgery is not required and would not be appropriate.&nbsp; This would be best treated with liquid nitrogen or even one of several topical prescription medication, of which there are several options. I would see your dermatologist or Mohs surgeon for this.&nbsp; Mohs micrographic surgery is still the preferred treatment for the removal of skin cancers (basal cell carcinoma and squamous cell carcinoma most commonly).&nbsp; When done by a qualified provider (member of the American College of Mohs Surgery, ACMS), Mohs offers the highest cure rate possible among skin cancer treatments.&nbsp;

I had a basal cell cancer on side of nose removed by MOHs and plastic surgery to remedy hole.

I have a pre-cancer area on tip of nose. What would be the best way to remove this area without deforming nose?

While smaller lesions tend to result in less skin excised for tumor clearance, infiltrative basal cell carcinomas do have a tendency to spread out in a subclinical way beyond the visible lesion.&nbsp; It's very difficult to say at the outset of any Mohs case what will be required in the removal of the tumor.&nbsp; And in some cases, I've found the pathology from the biopsy underestimates the true aggressiveness of the skin cancer.&nbsp; You're doing the right thing by having Mohs as your method of excision.&nbsp; Not only will this have a higher cure rate, but your surgeon will be looking at the tumor as it's being removed.&nbsp; This allows any additional concerning features to be noted and taken into consideration in his or her overall treatment plan for you.&nbsp;

I was diagnosed with an infiltrative basal cell carcinoma. It appears as a small red spot on the inner cartilage of my ear. My question is will it be a large procedure to have it removed? I am also concerned that it has spread elsewhere because it is infiltrative. Would this be the case?

If the basal cell carcinoma is small in appearance, does this mean that it will be a smaller surgical procedure?

The Vbeam is a pulse dye laser which primarily targets lesions with strong vascular (blood vessel) component.&nbsp; As such, it will work well for some of the redness and scarring you have.&nbsp; Given that yours is mild, one treatment may suffice, however in our office we always counsel patients that 2-3 treatments may be necessary to see a sufficient reduction in redness.&nbsp; For some of the scarring you have, a fractionated resurfacing laser would also be beneficial and should be considered once the redness has improved. &nbsp;&nbsp;

I talked to my dermatologist over the phone and she said that you only need one for acne scarring but I've read you're supposed to get more than 1. Will I need to? And will the laser help me?

Will a V beam laser help my redness leftover from acne? How many treatments will I need?

The primary reason for your soreness is probably all of the bruising and swelling you've experienced post operatively.&nbsp; It's not uncommon following Mohs excisions and reconstructions on the face for patients to have significant bruising at and below the operative site due to the many blood vessels on the face.&nbsp; In general, you should follow the instructions of the surgeon performing the procedure for post operative care guidance.&nbsp; Vaseline (petrolatum) is relatively insert and unlikely to cause you to have a reaction.&nbsp; Many over-the-counter topical antibiotics are common causes of allergic contact dermatitis (Neosporin being one of the main offenders) which is why most dermatologists and Mohs surgeons will recommend plain Vaseline to be applied to surgical sites.&nbsp; But with any concerning changes at your surgical site (worsening redness, discharge, tenderness, bleeding or swelling), contact your surgeon as he or she may want to see you in person for a more thorough evaluation.&nbsp;

My skin is getting sore, and looks blistered. i was probably putting too much Vaseline on. It's better since i cut back, but still uncomfortable when i use it. Itches.

Should I keep using Vaseline if I'm having a reaction? (photos)

There should be no problem receiving these two treatments in close proximity time wise.&nbsp; Two of the main treatments that come to mind to me that you would not want on the same day would be a botulinum toxin and sculptra.&nbsp; This is mainly because self massage of treated areas is required after sculptra, and you would not want to accidentally massage an area treated with botulinum toxin due to the risk of product migration.&nbsp; This should not be an issue with radiesse as no massage is required post treatment.&nbsp;

can these 2 be given within a week of each other without adverse effects?

Can botox injections be given along with radiesse high on cheeks?

Pulse dye laser treatments will vary depending on the provider and your geographic location.&nbsp; In general, this is a good laser for a variety of lesions (including scars) with a vascular or red component, though several treatments may be required depending on the appearance of your skin and its response to treatment.&nbsp; See your dermatologist or plastic surgeon for a consultation, as you may need to consider a combination of laser types to see maximal aesthetic benefit.&nbsp;

I've had post-acne red marks along my cheeks and chins for almost 10 years. Is the pulsed dye laser the best treatment option to get rid of these marks? Is their any downtime after this procedure is performed (can I go back to work and wear makeup the day after the procedure is performed)? What is the standard cost for this procedure? Thank you!

What is the cost and how successful is a pulsed dye laser for treating post-acne red marks?

Botulinum toxin injections (Botox being one example brand) will certainly soften the wrinkles around your eyes.&nbsp; It will help with the wrinkles that appear with facial muscle movements (smiling in this case).&nbsp; There may also be a component to these wrinkles which is present at rest (when not smiling).&nbsp; Laser resurfacing would be more helpful for these deeper wrinkles.&nbsp; If done properly, botulinum toxin injections to some of the wrinkles around your eyes should give you some improvement without affecting your smile.&nbsp;

Hello, I am a happy person and smile a lot. As a result I have very deep and a lot of permanent wrinkles around my eyes (crows feet and under eye). I am considering Botox, but I'am afraid that it would change the way I smile. Ideally I'd like just to just soften my wrinkles, not completely erase them. I would like to still be able to have the same facial expressions, just less intense. Is this possible with less Botox? Or does less Botox mean it won't last as long?

Just a little Botox for crows feet possible?

Treating the specific portions of the right side of your frontalis muscle with a botulinum toxin (Botox, Xeomin, Dysport) will help to relax/lower and soften the arch of the right eyebrow.&nbsp; In treating any areas of the forehead, it's always important to be careful and not to overtreat with botulinum toxin as this can lead to a feeling of a heavy brow and can be quite bothersome.&nbsp;

I have an asymmetry in my eyebrows. It's very severe when I smile. My right eyebrow goes up and my left drops down. They seem to move in opposite directions. A small part of the asymmetry is caused by me removing too much of my arch on the left eyebrow which makes it look lower. But most of it is due to my muscles. Looking at old pictures, I've always been asymmetrical, as I'm sure most people are. But it's recently gotten much harsher. Options? Botox? I want the eyebrow that goes down to go up.

Option for asymmetrical eyebrows? (Photo)

E. Eugene Bain III, MD

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