Surgical Dermatology

Types of skin growths—malignant and benign

Malignant (cancerous)

Basal cell carcinoma (BCC)

The most common and least serious growth. It typically appears as a shiny, small lump on sun-exposed skin. It may bleed, develop a crust, seem to heal, and then bleed again. Although these tumors grow slowly, they can become very large and penetrate deeply.

Squamous cell carcinoma (SCC)

May appear as a bump, a red scaly growth, or an ulcer. SCC can spread beyond the skin to the lymph nodes and internal organs, and can even cause death.

Melanoma

The least common but most serious form of skin cancer. It usually appears as a dark brown or black mole with uneven borders and irregular colors, or has shades of black, blue, red, or white.

Benign (non-cancerous)

Many non-cancerous growths such as actinic keratoses, seborrheic keratoses, cysts, warts, and moles can be removed by using dermatologic surgery methods.

Actinic Keratoses

Rough, reddish, pre-cancerous lesions that appear on sun-exposed areas of the body

Seborrheic Keratoses

Warty, raised tan or brown growths with a thick, rough surface that often become itchy

Cysts

Small closed sacs that contain fluid or solid material

Moles

Common skin growths that are usually tan or brown in color, sometimes raised, and come in a variety of shapes and sizes. Over time, some moles may change in color, height, size or shape.

Warts

Growths that are caused by the human papillomavirus (HPV) and consists of thick layers of skin. People of all ages may develop warts anywhere on the skin, but in most cases, they appear on the fingers, near the fingernails, or on the hands.

Treatment for Skin Cancer

Treatment for skin cancer varies according to the location, size, aggressiveness of the cancer, and the patient's general health. In most cases, the dermatologist will take a small piece of the abnormal growth for an evaluation (biopsy). The tissue is examined under a microscope to determine if it is malignant.

Mohs micrographic surgery

Developed by Dr. Frederick Mohs, Mohs micrographic surgery is a state-of-the art, accurate and microscopic method for the precise removal of skin cancer. Mohs takes only the tumor and leaves your healthy skin intact. Mohs surgery is the treatment of choice for skin cancers in critical areas and has the greatest chance of a good cosmetic and functional result. Mohs also has the highest cure rate of any treatment option, up to 99% for most tumors.

Dr. Cameron Chesnut is board certified in dermatology and fellowship trained in Mohs micrographic surgery, reconstructive plastic surgery, and cosmetic surgery.

Cosmetic Surgeries

Blepharoplasty

What is blepharoplasty?

Eyelid surgery, or blepharoplasty, is a surgical procedure to improve the appearance of the eyelids. People may also seek eyelid surgery when they feel tired, have heavy eyelids or difficulty with their vision, and when they can no longer apply makeup to the upper lids.

Surgery can be performed on either the upper and lower lids, or both.

Blepharoplasty can treat:

Loose or sagging skin that creates folds or disturbs the natural contour of the upper eyelid, which can sometimes impair vision or feel heavy and contribute to a feeling of having tired eyes
Excess fatty deposits that appear as puffiness in the eyelids
Bags under the eyes
Drooping lower eyelids that reveal white below the iris
Excess skin and fine wrinkles of the lower eyelid

How do I choose my blepharoplasty surgeon?

There are four main medical specialties that gain experience with blepharoplasty during their residency training after medical school:

Dermatology
Opthamology
Ear, Nose, and Throat
Plastic surgery

During residency training, however, exposure is relatively limited. In addition to being board certified in one of the above specialties, it is best to seek a surgeon who has performed additional training, called a fellowship, which involves eyelid surgery. Those fellowships include:

Dermatologic surgery (dermatoplastic surgery) for dermatology
Oculopastic surgery for opthamology
Facial plastics for ear, nose, and throat
Cosmetics fellowship for plastic surgery

Be wary of the “cosmetic surgeon” who has not completed a fellowship. General surgeons, oral surgeons, and others may be “board certified” in cosmetic surgery, which is a certificate that requires no specific fellowship training or training background, and they may not have received cosmetic training in their residency.

Dr. Chesnut is board-certified in dermatology and fellowship-trained in Mohs micrographic surgery, reconstructive plastic surgery, and cosmetic surgery. He completed the exclusive and sought after Procedural Dermatology Fellowship at UCLA, training in the most demanding cosmetic and surgical environments of Beverly Hills, Hollywood, and Los Angeles.

His fellowship at UCLA featured a rigorous, full integration of all four “core cosmetic” specialties: plastic surgery, facial plastic surgery, oculoplastic surgery, and dermatologic surgery. Through this one-of-a-kind integration, Dr. Chesnut is a well-rounded and cross-pollinated surgeon. He has an unparalleled foundation in cosmetic surgery, as well as laser and aesthetic dermatology. Within cosmetic surgery, he chooses to focus solely on facial and neck rejuvenation.

Blepharoplasty Candidates

In general, good candidates for eyelid surgery include:

Healthy individuals who do not have a chronic, life threatening illness or medical conditions that can impair healing
Non-smokers
Individuals with a positive outlook and specific goals in mind for eyelid surgery
Individuals without serious eye conditions

Remember that the eyelids are part of the face. The appearance of a drooping upper lid may also be due to relaxation of the forehead skin and eyebrow. Sometimes a drooping eyelid is caused by stretching of one of the upper eyelid muscles.

Dr. Chesnut will evaluate your anatomy thoroughly to determine the causes of your eyelid appearance, and what procedures might best remedy them.

Blepharoplasty Results

The results of eyelid surgery will be long-lasting. Your final results will appear within several weeks, but it may take up to a year for incision lines to fully refine.

While eyelid surgery can be expected to correct certain conditions permanently, you will continue to age naturally. Life-long sun protection will help to maintain your results.

Satisfaction with your new image should continue to grow as you recover from surgery. As swelling and bruising subside, the results of eyelid surgery will reveal a smooth, better-defined eyelid and surrounding region and an alert and rejuvenated appearance.

Although good results are expected from your procedure, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single surgical procedure and another surgery may be necessary.

Following Dr. Chesnut’s instructions is essential to the success of your surgery. It is important that the surgical incisions are not subjected to excessive force, abrasion, or motion during the time of healing.

Dr. Chesnut will give you specific instructions on how to care for yourself after your eyelid surgery.

Your blepharoplasty consultation

During your eyelid surgery consultation be prepared to discuss:

Your surgical goals
Medical conditions, drug allergies, and previous medical treatments and specifically any problems you have had with your eyes
Current medications, vitamins, herbal supplements, alcohol, tobacco, and drug use
Previous surgeries

Your surgeon will also:

Evaluate your general health status and any pre-existing health conditions or risk factors
Take photographs
Discuss your eyelid surgery options
Recommend a course of treatment
Discuss likely outcomes of eyelid surgery and any potential risks
Be sure to ask questions.
It’s natural to feel some anxiety, whether it’s excitement for your anticipated new look or a bit of preoperative stress. Don’t be shy about discussing these feelings with Dr. Chesnut.

Please call our office at 509-456-8444 to schedule your blepharoplasty consultation with Dr. Chesnut.

Facelift

What is a facelift?

A facelift, or rhytidectomy, is a surgical procedure that improves visible signs of aging in the face and neck, such as:

Loss of skin tone in the lower face that creates jowls
Loose neck skin and banding of the neck
Excess fatty deposits under the chin and jaw that can give even a person of normal weight the appearance of a double chin
Sagging in the middle of your face
Deep creases below the lower eyelids
Deep creases along the nose extending to the corner of the mouth
Fat that has fallen or has disappeared

The loss of youthful contours in the face and neck can be due to a variety of factors, including heredity, gravity, environmental conditions, and stress.

Rejuvenation procedures typically performed in conjunction with a neck and facelift are browlift, to correct a sagging or deeply furrowed brow, and blepharoplasty, to rejuvenate aging eyes.

What a face lift won't do:

As a restorative surgery, a facelift does not change your fundamental appearance and cannot stop the aging process.

A facelift can only be performed surgically; non-surgical rejuvenation treatments cannot achieve the same results, but may help delay the time at which a facelift becomes appropriate and complement the results of surgery.

How do I choose my facelift surgeon?

There are four main medical specialties that gain experience with lifting procedures during their residency training after medical school:

Dermatology
Opthamology
Ear, Nose, and Throat
Plastic surgery

During residency training, however, exposure is relatively limited. In addition to being board certified in one of the above specialties, it is best to seek a surgeon who has performed additional training, called a fellowship that involves cosmetic surgery. Those fellowships include:

Dermatologic surgery (dermatoplastic surgery) for dermatology
Oculopastic surgery for opthamology
Facial plastics for ear, nose, and throat
Cosmetics fellowship for plastic surgery

Facelift Candidates

In general, good candidates for a facelift include:

Healthy individuals who do not have medical conditions that impair healing
Non-smokers
Individuals with a positive outlook and realistic expectations

Facelift Results

As swelling and bruising subside, the visible improvements of a facelift appear. Your final result should not only provide a more youthful and rested appearance, but also help you feel more confident about yourself.

It may take a few months for swelling to fully dissipate and for incision lines to mature.

Life-long sun protection and a healthy lifestyle will help extend the results of your rejuvenated, more youthful appearance.

Following Dr. Chesnut’s instructions is essential to the success of your surgery.

It is important that the surgical incisions are not subjected to excessive force, abrasion, or motion during the time of healing. Avoid wearing any clothing that must go over your head.
Your will receive specific instructions on how to care for yourself.

Your Facelift Consultation

During your facelift consultation be prepared to discuss:

Your surgical goals
Medical conditions, drug allergies, and medical treatments
Current medications, vitamins, herbal supplements, alcohol, tobacco, and drug use
Previous surgeries

Dr. Chesnut will also:

Evaluate your general health status and any pre-existing health conditions or risk factors
Discuss your facelift options
Examine and measure your face
Take photographs
Recommend a course of treatment
Discuss likely outcomes of a facelift and any risks or potential complications

It’s natural to feel some anxiety, whether it’s excitement for your anticipated new look or a bit of preoperative stress. Don’t be shy about discussing these feelings with Dr. Chesnut.

Please call our office at 509-456-8444 to schedule your facelift consultation with Dr. Chesnut.