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Beauty is in the eye of the beholder. And that is a very BIG problem. What you consider beautiful may not be the same as what the doctor considers beautiful. From your photo, it appears that your left cheek is fuller than the right, and this could be improved by fat removal. But deciding really n~ds to be done in person and not from a photo. Aesthetic consultations are usually free of charge. I suggest you have several opinions from several doctors. It may help to get a better idea of what you should have done.       jlr 

The photo attached shows my right side (top) and left side (bottom). I prefer the look of my right side, and am wondering whether jaw filler would improve the look of my left?

Would jaw filler improve the appearance of my left side? (Photos)

Anything can be cut out. It could also be lasered out. There are 2 problems with removal. One is that, regardless of how it's removed, you will be left with a scar. And NOBODY can tell you what that scar may look like. The second is that you may still be left with some residual tattoo pigmentation. 

Another solution you can consider is having it retatooed with a more acceptable subject. So, consider your options and choose wisely.     jlr 

I have this script tattoo on my forearm which is 7.5" x .8" for the most part, at the widest it's 1.7 at letter 'b'. it's heavily scarred which makes it even harder to remove. I can't spend the time and money on laser, I'd rather end up with a long scar. Can this tattoo be excised, in one or two session? Please answer in regards to excision and not laser. Thank you

Is my tattoo removable through excision? (Photo)

Melanoma is the most dangerous skin cancer to have. Delaying treatment is extremely dangerous. In fact, the only melanoma patients I have ever lost are those whose treatment was delayed by at least one week. Although other doctors may have differing opinions, mine is based on over 40 years of experience, most of which has been in academic centers. Why, in heaven's name, would you, risk your life?

I have pictures of this spot from two years ago. It is on the outside right calf muscle. Went to the derm for something totally different and she noticed this spot and thought it needed biopsy. 2 days later she called to say it was melanoma in situ. She knows im getting married in one month but she said she would not wait. From what ive read some doctors dont even call this level a melanoma and ive had this for as long as i can remember but now suddenly i cant wait a month to get it removed.

I was diagnosed with melanoma in situ on 9/26. My wedding day is Oct 26 (1 mo later). Can I wait till after wedding to remove?

Skin Cancer Treatment

The mole you have is unusual in several ways and should be removed. The feeling about treating melanoma varies with each doctor. My feeling on suspicious lesions is complete removal and sending the specimen for a STAT report which is having the report ASAP, usually 48 hours. I have the patient come back as soon as the report is received. I go over the report and if it is melanoma, remove it immediately with the appropriate margin suggested by M.D, Anderson. The most important aspect regarding melanoma is its depth, which determines the extent of the wide excision.I believe that melanoma should be removed as quickly as possible and having the tissue findings incorporated with patient factors to determine how likely the melanoma will act in that patient. I will share with you that many doctors do not operate that quickly, which I believe is foolish. I am very aggressive with melanoma and fight to win.I hope this answers your question and wish you the best of luck.         jlr

I have never seen this mole before - it’s flat, seems to have a dark ring around the edge and isn’t a solid color. I am making an appointment with my dermatologist ASAP - I just want to know if this could be melanoma? If so - how quick can it spread?

Could this be melanoma and how quick can it spread? (Photos)

The defect you have is called a pin cushion and/or a trap door defect. It can be readily improved with fractional CO2 laser resurfacing. Be aware, however, that the result will depend on the experience and skill of the doctor performing the procedure. Hope this helps, and good luck in your selection of a doctor.           jlr

My skin flap is a lot thicker than the rest of my skin and it has a big divot around it where it didn't adhere to the rest of my nose. It looks like a patchwork quilt and the big blog of skin looks like it was just pressed on there, and looks even worse in person. Can my nose be cut apart, skin trimmed off, pulled tighter and resewn to pull the thickness out? Or can the whole thing be sanded off at least 1/16 of an inch? Or I have also seen doctors burn off thick skin with a hot loop instrument?

My nose flap from skin cancer didn't heal properly, what kind of revision surgery is possible? I look deformed. (Photo)

In theory, photodynamic therapy  should be ideal for treating  basal cell and squamous cell carcinoma . However ,  there are no studies that prove its efficacy .  I was involved in the original work  to test  photodynamic therapy against  skin cancers ,  but disagreements among the group  proposing the study  led to cancellation of the study itself .

Is Photodynamic therapy a good treatment for someone who has a history of basal and squamose cell cancer on her face and head.? 4 Moh's procedures , "f-udex creme" , and cryo treatments. Thank you

How effective is photodynamic therapy for treating basal cell or squamose cell skin cancer?

Wow both radio frequency and CO2 laser can give excellent results, I would choose the Doctor Who has the experience  and the expertise with the fractional CO2 laser.       jlr

I was told both laser and radio frequency are used to stimulate collagen. Which would be superior to treat wrinkles? Or do they do this in different ways so maybe they both can be combined? It also seems like radio frequency is more comfortable and with less downtime so I'm thinking of RF. If you had to choose one, which would it be?

Is Fractional laser or radio frequency better for fine lines and wrinkles? (Photo)

While a forehead flap is one option, it is a 2 stage procedure. I would think a well designed cheek flap, a one stage procedure, would be a much better option, both functionally and cosmetically. And, since you are in Houston, I would suggest you be seen and evaluated at M. D. Anderson, considered #1 for melanoma.    Best of luck to you.         jlr

I have a melanoma near my eye and close to side of nose . The doctor is recommending a forehead flap to minimize scarring under my eye . He also said a patch from another area won’t match face. My MOHS surgery is coming up and I’m struggling with the decision to flap or not flap. A flap will leave me with a second scar .

I have a melanoma. Should I get a forehead flap to minimize scarring? (photo)

Your bumps are at regular intervals and most likely represent placement of the deep absorbable sutures, to which your body is reacting. Once your body has cleared the sutures out, these bumps will go away. The treatments suggested will lighten your wallet, but probably not do much more than that. When absorbables don't absorb, it can take your body up to a year or more to resolve the problem for you. It's one of the reasons I avoid absorbable sutures on the face unless absolutely necessary.I know it's brobably not what you wanted to hear, but it is most likely what is going on. Save your money and et Mother nature do her job. Best of luck.                jlr

1/28/18 Moh’s for Nodular BCC on forehead. June 2018 told dissolving stitches still there. 4 treatments of Ematrix. Yearly body scan all clear,. Told lumps &amp; bumps normal, maybe microneedling would help. Noticed soreness on one side of scar, with redness, bumps, &amp; a caved in appearance. Derms office said to go to PS. Told them they should look at it first. Now they say it could be Rosacea, try a few months of doxycycline...if that doesn’t work, I’m to go to PS. I’m stressed.... Thoughts?

Can Rosacea develop just across scar line 16 months after Moh’s surgery? (photos)

You are correct. The black portions of your skin grassed have died. The most common reason for skin grafts not taking is a history of smoking. If you were not asked about this, I would consider that doctor error. Unfortunately, even without a history of smoking, there is no guarantee that a skin graft would take. I'm surprised that your doctor didn't discuss a forehead flap for a wound that size.

You now have two options. The first is to allow the wound to heal by itself. In order to enable the best end result, clean the dead portions of the graft thoroughly, cover the areas with Vaseline, and apply a dressing. Leave the dressing in place except when cleaning. Clean with sterile normal saline any yellow drainage in the wound. The portions of the wound that did not take should begin to fill up with granulation tissue. Granulation tissue is healing tissue very rich and blood vessels that will promote healing to the surface. At the end of this process new skin will then cover over the wound and contract the areas to a smaller size. The final result could be reasonably normal in appearance, or perfectly Dreadful. The area could then be resurfaced with a carbon dioxide laser or repaired by a facial plastic surgeon. Please know that a facial plastic surgeon is one who has undergone a facial plastic surgery Fellowship. The second option is to see a facial plastic surgeon right now for other options. I suggest taking the first option as you might be surprised at the quality of the final appearance of the wound. I wish you the best of luck with this.       jlr

MOHS surgery (infiltrative BCC, tip of nose), 3.5 weeks ago by dermatologist / MOHS surgeon (not plastic surgeon). Insufficient skin for a flap (28mm defect, 2.2mm deep). Did skin graft from clavicle. Told could have plastic surgery later if necessary. He so far pleased with result. Are the black areas where the graft has failed? I seem to be beginning to see lumps, bumps &amp; a 'dip'. Suggestions: dermabrasion and steroid injections. Should I (&amp; at which point) see plastic surgeon for advice?

Are the parts of the black areas of the graft that haven't taken and died? Should I see a plastic surgeon? (Photos)

John Louis Ratz, MD

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