FOR PATIENTS

Cosmetic procedures include areas that patients request to have removed, but pose no medical threat.  These areas can be skin tags, benign pigmented lesions, moles, etc.  Typically, insurance companies will not pay for these procedures so they must be paid in full at the time of service.  Please contact our billing office to obtain an estimate prior to your appointment.

Should you have any additional questions about your appointment, or if we can assist you further in any way, please feel free to call us at (270) 554-7546.

Caring For the Excision Site:

1. Keep site or sites dry for 24 hours.
2. Wait for 24 hours to remove bandage unless you are having redness, itching, or swelling around the bandage. If having redness, itching, or swelling around the bandage, please call the office for further instructions.
3. After removing the tegaderm patch, cleanse the area(s) with mild soap and water during normal shower. DO NOT use Hydrogen Peroxide because it can compromise the healing of the surgical site.
4. After 24 hours you may shower as usual, but do not submerge under water for two weeks.

Obtaining Your Results:

Please allow two weeks for pathology results to be finalized. If you have not received notification within three weeks, please contact our office or check on Patient Portal. Patient will only be notified if lesion is cancerous or if further treatment is required.

Things You Should Know:

1. After anesthetic wears off, you may experience some mild pain or discomfort. Usually Tylenol or over-the-counter pain reliever is adequate.
2. Please avoid Aspirin or Ibuprofen the day of your procedure (they may thin the blood and reduce clotting time) unless previously discussed with our office or prescribed by another physician.
3. Please call for any unusual symptoms of pain, bleeding, or sign of infection. Signs of infection include redness, streaking, heat at excision site, or any yellow or green oozing.
4. Your excision site was closed with Polysorb suture. Polysorb suture is a dissolving suture placed under the skin. In most cases i,t takes about three months for your body to absorb the dissolving suture. (no sutures to remove)
5. Steri-strips have been placed over the excision site and should be left alone. They will eventually peel off.

To Aid In Healing And Reduce Scaring:

1. Protect the excision site from the sun with sunscreens and/or bandage for one year to reduce scarring.
2. All excisions of the arms, legs, and back have a tendency to spread and form a wider scar. Steri-strips and/or butterfly strips can be applied for 8-12 weeks after steri-strips have come off to decrease the risk of scarring.
3. You may purchase a product called Silagen here at WellSprings SkinCare to apply after steri-strips come off.

Preparing for Blu-U with Levulan:

1. Avoid excessive sun exposure 1-2 weeks prior to treatment.
2. Avoid applying makeup or heavy moisturizers on the day of the treatment.
3. Do not shave the skin the morning of the treatment.

During the Treatment:

1. You will come into the office and have the medication (photosensitizer) applied to your skin that will be treated. You will then sit in the lobby for a specific amount of time depending on the area of the body being treated to allow the medication to become sensitized.
   (Approximately, one hour- face/scalp, Approximately two hours chest arms, & legs)
2. After incubation, you will be placed in front of the Blu-U light box for the treatment. The treatment lasts for 16 minutes and 40 seconds. This can be uncomfortable.
3. We then remove the Levulan from the skin with warm water and you will be able to leave the office.

We will file this procedure with your insurance carrier. You may have a deductible or co-pay due based on your individual insurance plan. If you would like to know if this service is covered or what your out of pocket expense will be, you can contact your insurance company and get a quote for the CPT code. Please contact our office to obtain the CPT code prior to calling your insurance company.

For more information about the treatment, please contact our office.

Post Treatment Care

1. Avoid sunlight or bright indoor lighting for the next 48 hours. This includes bright windows, fluorescent and incandescent lighting. Limit time at computer screen, exercise caution with prolonged TV exposure and sit > 10 feet from TV.
2. If you must go outdoors during the first 48 hours post-treatment, use a thick coat of sun blocking agents containing ingredients such as zinc oxide to treated areas. You may reapply every two hours to provide maximal coverage. Protect the head, face, ears, and neck by wearing a wide-brimmed hat or similar head covering of light, opaque material. Wear long sleeves and pants if extremities are treated. Lightweight gloves should be worn to cover backs of treated hands.
3. Keep skin well moisturized with gentle cleansers and moisturizers such as Avene or Free & Clear Gentle Cleanser, Vanicream Lite, Cheryl Lee Hydrate, Correct, & Perfect, Ceramide Cream, Biafine, and Cheryl Lee Lip Balm. See the staff in the WellSprings SkinCare, as we do offer these products for sale in our facility.
4. Avoid all products that may irritate or exfoliate
5. Use cool compresses or ice packs as needed for swelling or itching.
6. Tylenol or Advil may be taken according to the manufacturer recommendations for tenderness or discomfort.
7. Daily use of SPF 30 sunscreen is recommended. Examples of acceptable sunblocks are Vanicream, Avene, or Elta (Elta is a tinted sunscreen, for the face) or sunscreens with zinc oxide or titanium dioxide. See the staff at WellSprings SkinCare, as we do offer these products for sale in our facility.

After treatment, you may experience the following:

1. Peeling or flaking of the skin
2. Redness
3. Dark spots
4. Swelling
5. Stinging/burning-usually lasts 24 hours
6. Tenderness
7. Oozing
8. These effects usually resolve in 5-7 days and should be resolved in 3-4 weeks completely.

If you experience the following, please call your care provider:

1. Severe pain
2. Open, weeping skin
3. Blisters
4. Temperature > 100.5

Note:

Follow up with Physician/Technician approximately six weeks post-treatment

1.  Avoid prolonged bathing and hot water while bathing.
2. Apply cream based moisturizer to body 3-4 times per day. The best and most important time to apply is within 3-5 minutes after toweling off following bathing. Vanicream or Avene XeraCalm are recommended products and are available at WellSprings SkinCare.
3. We recommend ‘Simple Truth’ laundry detergent, ‘FREE & CLEAR’ (at Kroger) or ‘Tide Purclean’ and rinsing clothes twice on rinse cycle of wash. Fabric Softener and/or Dryer Sheets are not recommended.
4. Use soap substitute, such as ‘Free and Clear Cleanser’ (available in WellSprings SkinCare) for bathing. The products which produce a heavy lather have excessive amounts of detergent which ultimately can irritate the skin.
5. Avoid scratching areas of the skin. If itching cycle starts, take oral, over the counter, medications such as Benadryl to suppress. If this medication is contraindicated for you, we advise you to avoid using.
6. If itching persists, avoid scratching areas. Apply pressure to area or apply cold compress to help alleviate the symptom. The scratching worsens the rash.
7. Avoid smoking in home/cars and around affected person.

Due to increased risk of skin infections to the lower extremities, we want to take special precaution in the care for these area(s).

1. Cleanse area(s) twice a day with Hibiclens two weeks before and after procedure.
2. Avoid smoking for two weeks before and two weeks after procedure.
3. Apply Mupirocin Ointment to sutures and/or steri-strips twice a day for two weeks after procedure.
4. For best results and to restore the skin barrier you can purchase Cheryl Lee Ceramide + cream at WellSprings SkinCare for $50.00.  You will need to apply two weeks prior and two weeks after your procedure.

The further away an area is from your heart, the longer it can take to heal.

If there is poor circulation or swelling in the area(s), the longer it takes to heal.

Keep your legs elevated above the level of your hips as much as possible for the first two weeks after surgery

Preparing for the Patch Test:

1. Avoid sun to patch test area (back) 1-2 weeks prior to having them applied.
2. Discontinue oral steroids the Saturday prior to having the patch test applied on Tuesday.
3. Do not use any creams or lotions to the skin on the back prior to the patch test.
4. If you have had a “steroid shot” prior to the test, please advise us as there are waiting times depending on the dose you were given.  You will also need to get the dose information from the provider who administered the shot.
5. You will have the test applied on Tuesday by a nurse and removed on Thursday of the same week.  We will read it then and have you come back the following Monday for the final reading.

For additional information on the test, go to www.truetest.com.

After the Patch Test is Applied:

1. It is okay to take oral antihistamines for itching (Benadryl, Claritin, Zyrtec, Allegra, etc.).
2. Do not get the area where the test has been applied wet.  We would prefer sponge bathing while the tape is on the skin.
3. No sun exposure to the testing area.
4. No oral or injected steroids while we are testing you.
5. If the tape lifts, please reapply with a hypoallergenic tape.
6. Avoid sweating while the test is applied.
7. Avoid any twisting movements like vacuuming, working out, etc. that will pull the patch test strips off the skin.
8. When we remove the patch test, we will be marking your back with sharpie markers.  Please wear an old shirt and underclothing as this type of marker is permanent and can ruin your clothing.

After Patch Test is Removed:

1. Do not use topical steroid creams to the testing area at any time until we have had the final reading.
2. You can take a shower, but you cannot have the water run on your back.  We encourage you to face the shower head and only allow the water to hit from the front of your body.  Do not dry aggressively as some moisture gets on your back.  You can lightly pat the area dry with a towel.
3. Do not get in a hot tub, pool or other water recreation until the final reading has occurred.
4. You may notice your dermatitis may get worse, which is a normal occurrence.  Patch testing does not cause symptoms such as headache or upset stomach.