How Likely Is An Indented Scar After Biopsy Of Sabaceous Hyperplasia?

I have treated thousands of lesions of sebaceous hyperplasia, never with a scar. You may need more than one treatment so as to avoid a scar, but you're much better off going slowly & gently and doing a touch up treatment, than having to deal with an indented scar from an overzealous treatment. Speak with an experienced dermatologist to get it done properly.

I recommend excisional, rather than shave, biopsy because I have more control over the healing of the scar if I am able to suture the wound. Also, whenever there is a concern about malignant melanoma, a shave will prevent an accurate determination on the depth of the lesion, which is essential in formulating a treatment plan. The tip of the nose is one of the worst areas in which to perform a formal excision and closure because there is little if no extra skin and scarring is always a concern.

In practice, in this situation the best option is for the doctor caring for you to determine how to remove the lesion. Sebaceous hyperplasia, angiofibromas, intradermal nevi, as well as many other types of lesions, can be effectively treated by shave removal and light electrodesiccation of the wound. Any type of surgical procedure leaves a scar. Sometimes shave removal is the best option and sometimes excision and closure is the best option. Your doctor should take into account the factors that might impact wound healing and scarring and present you with the best option given the lesion being treated, the location, your skin type, etc. If you're still not sure, I would recommend that you ask questions of the doctor or even get a second opinion. But I still think that shave removal and light electrodesiccation is a good option for something like sebaceous hyperplasia on the nose. Of course, if there is any confusion as to what the lesion is (i.e. could it actually be a basal cell carcinoma), the specimen should be sent for pathological evaluation.

The way you do the biopsy is very important. This should be discussed with you so that you are aware of how things are done. Shave biopsies don't heal well and they grow back. Excisional biopsies are the gold standard.  Make sure you ask all of these questions with your surgeon.

If your dermatologist is sure that the lesion is sebaceous hyperplasia, you will get the best cosmetic outcome with electrodesiccation followed by curettage. If the lesion grew rapidly and has any chance of being a basal cell skin cancer, a biopsy is needed.