Cystic removal from chin. Would radio frequency removal an option, or is surgical extraction better? (Photo)

Question

I would like to have a small cyst removed from my chin. My primary care provider mentioned that it was benign. She mentioned the sac would need to be removed to prevent reoccurrence. Is a surgical extraction better? Would radio frequency removal an option? What is the difference between the two options?

Anna Chacon, MD, FAAD · Answer

When considering the removal of a benign cyst from the chin, both surgical extraction and radio frequency (RF) removal are viable options, each with its own advantages and considerations. Here’s a detailed comparison to help you make an informed decision:

Surgical Extraction

Procedure:
- **Incision and Removal**: A small incision is made over the cyst, and the entire cyst, including the sac, is carefully removed.
- **Closure**: The incision is then sutured closed.

Advantages:
- **Complete Removal**: Surgical extraction ensures that the entire cyst, along with its sac, is removed. This significantly reduces the risk of recurrence.
- **Definitive Diagnosis**: The removed tissue can be sent for histopathological examination to confirm the benign nature of the cyst and rule out any other conditions.

Considerations:
- **Scarring**: There is a risk of scarring, although the incision is typically small and made in a cosmetically sensitive manner.
- **Infection**: As with any surgical procedure, there is a risk of infection, though this is generally low with proper care.
- **Downtime**: Minor downtime is expected for healing, and sutures may need to be removed in a follow-up visit.

Radio Frequency (RF) Removal

Procedure:
- **Energy Application**: RF energy is used to heat and destroy the cyst tissue. The heat causes the cyst to break down and be absorbed by the body over time.
- **Minimal Incision**: A small incision may still be needed, but it is usually smaller than that required for surgical extraction.

Advantages:
- **Minimally Invasive**: RF removal is less invasive than traditional surgery, often resulting in less tissue trauma.
- **Reduced Scarring**: The procedure typically results in minimal scarring compared to surgical extraction.
- **Quick Recovery**: Patients often experience quicker recovery times and less postoperative discomfort.

Considerations:
- **Recurrence Risk**: There is a higher risk of recurrence if the cyst sac is not completely removed or destroyed. This is a key point, as your primary care provider mentioned the importance of removing the sac to prevent reoccurrence.
- **Effectiveness**: While effective for some types of cysts, RF removal may not be suitable for all cysts, especially if they are larger or deeply embedded.

When deciding between surgical extraction and RF removal, consider the following factors:
- **Size and Depth of the Cyst**: Larger or deeper cysts might be better managed with surgical extraction to ensure complete removal.
- **Cosmetic Concerns**: If minimizing scarring is a priority, RF removal might be preferred, though surgical techniques are often very careful about cosmetic outcomes.
- **Recurrence Risk**: If recurrence is a significant concern, surgical extraction may be the better option due to its thoroughness in removing the entire cyst sac.
- **Recovery Time**: RF removal typically offers a quicker recovery with less downtime.

Both surgical extraction and RF removal have their own benefits and limitations. Given the emphasis on removing the cyst sac to prevent recurrence, surgical extraction might be the more appropriate option for ensuring complete removal. However, if minimizing scarring and recovery time are major concerns, and if the cyst is suitable for RF treatment, it could be a viable alternative.

Discuss these options in detail with your healthcare provider or a dermatologist to determine the best approach based on the specific characteristics of your cyst and your personal preferences.

Nelson Lee Novick, MD · Answer

First, you would be wise to consult with an experienced, board certified cosmetic dermatologist for cyst removal. This can usually be done under local anesthesia by making a small incision in the top center of the cyst (small enough that it typically requires no stitches and hence no risk for stretch scars or stitch marks) through which the contents and the cyst sac can be extruded with pressure. Once done, a pressure bandage can be placed and removed in about a day., and Voila no more cyst. 
Forget the expensive "bells and whistles" RF treatment. These gizmos, like fraxel lasers and other energy-based devices, tend to be just heavily marketed and social media influencer hyped "here-today-and-gone-tomorrow" fads with unproven and unreliable efficacy. Hope this helps and best of luck.

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