Skin Surgery Services at IVSI

Procedural Dermatology — What We Do and How It’s Performed

International Vein & Skin Institute offers a range of in-office procedures used to diagnose, remove, and treat skin lesions and growths. Each procedure is selected based on lesion type, depth, location, diagnostic requirements, treatment goals, and healing considerations.

All procedures are personally performed by Dr. Jozef Tryzno using sterile technique, appropriate anesthesia, and established medical standards. Surgical CO₂ laser technology is used for dermatologic incision and excision in place of a scalpel, as well as for hemostasis and controlled tissue ablation in selected procedures.

DIAGNOSTIC BIOPSY PROCEDURES

Biopsy procedures are performed to establish or confirm the diagnosis of a skin lesion through histopathologic examination when clinical examination alone does not provide sufficient diagnostic certainty.

PUNCH BIOPSY

A punch biopsy obtains a full-thickness cylindrical sample of skin for histopathologic examination and is particularly useful when evaluation of the deeper skin layers or the architecture of a lesion is important.

How it is performed:

Local anesthesia is administered
A circular punch instrument removes a full-thickness tissue sample
The biopsy site is typically closed with one or more sutures
Tissue is submitted for histopathologic examination

Punch biopsy is commonly selected for flat or pigmented lesions, inflammatory skin conditions, and lesions in which full-thickness sampling or assessment of depth is important.

For a small lesion, selection of a larger punch may remove the entire lesion; however, complete removal cannot be guaranteed. Histopathologic findings determine whether additional excision or other treatment is required.

SHAVE BIOPSY

A shave biopsy removes the clinically visible portion of a lesion at or through the superficial dermal level for histopathologic examination, without necessarily removing the entire depth of the lesion.

How it is performed:

Local anesthesia is administered
The lesion is removed tangentially using a shave instrument
CO₂ laser coagulation is used for hemostasis
No sutures are required; the biopsy site heals by secondary intention
Tissue is submitted for histopathologic examination

Shave biopsy is commonly used for raised or superficial lesions, including lesions with the clinical appearance of seborrheic keratoses and other exophytic skin growths, when this approach provides an appropriate diagnostic specimen.

Although the clinically visible lesion is removed, deeper portions may remain depending on the lesion type and depth. Histopathologic findings determine whether additional treatment is necessary.

EXCISIONAL BIOPSY

An excisional biopsy is performed when removal of the entire lesion is intended for diagnostic examination while preserving surrounding healthy tissue and important anatomic structures.

How it is performed:

Local anesthesia is administered
Incision is performed using a surgical CO₂ laser in cutting mode
he lesion is removed with a narrow surrounding margin
The wound is closed with sutures
Tissue is submitted for histopathologic examination

Excisional biopsy is performed with the goal of complete lesion removal while avoiding unnecessary removal of normal tissue. In many cases, the initial procedure also provides definitive treatment.

Complete removal cannot be guaranteed until histopathologic findings are available. Pathology may identify deeper extension, involved margins, or other characteristics requiring additional surgical excision. Lesion depth and anatomic location may also affect the extent of tissue that can safely be removed during the initial procedure.

THERAPEUTIC SKIN PROCEDURES

Therapeutic skin procedures are performed when the primary goal is to remove, drain, destroy, or otherwise treat the lesion itself, rather than primarily obtaining tissue to establish a diagnosis.

SURGICAL EXCISION

Surgical excision is performed when complete removal of a skin lesion with conservative margins is indicated.

How it is performed:

Local anesthesia is administered
Incision is performed using a surgical CO₂ laser in cutting mode
The lesion is removed with conservative margins
Depth and margin selection are tailored to the lesion and anatomic location
The wound is closed with sutures, often in layers depending on size and location
Removed tissue is submitted for histopathologic examination

Surgical excision is intended to remove the lesion together with a surrounding margin of tissue. Margin selection is based on lesion characteristics, clinical and pathology findings when available, and anatomic location.

INCISION & DISSECTION

Incision and dissection is used for removal of selected cysts, lipomas, and other lesions located beneath the skin, where access to the lesion and careful separation from surrounding tissue are required.

How it is performed:

Local anesthesia is administered
An incision is made using a surgical CO₂ laser in cutting mode
The lesion is identified beneath the skin
Careful dissection is performed to separate the lesion from surrounding tissue
Bleeding is controlled during the procedure using CO₂ laser coagulation or other hemostatic techniques as needed
The lesion is removed when separation can be safely completed
The wound is closed with sutures, often in layers depending on depth, size, and location
A drain may be placed when continued drainage is needed and typically remains in place for several days
Removed tissue is submitted for histopathologic examination when indicated

The size and location of the incision and extent of dissection depend on the depth, size, attachment, and anatomic location of the lesion. The goal is to provide adequate access for removal while preserving surrounding tissue and important anatomic structures.

INCISION & DRAINAGE (I&D) — CYSTS & ABSCESSES

Incision and drainage is performed for abscesses and inflamed, infected, or ruptured cysts, often when prompt treatment is needed.

How it is performed:

Local anesthesia is administered
A controlled incision is made to release pus, fluid, or cyst contents
The cavity is explored, irrigated, and curetted when indicated
For ruptured or inflamed cysts, identifiable portions of the cyst wall may be removed when feasible
Local treatment of the cavity is performed as indicated
Iodoform packing, other packing material, or a drain may be placed to support continued drainage and wound care
The wound may be partially closed or left open to heal by secondary intention

For an abscess, treatment focuses on drainage and management of the infected cavity. For an inflamed or ruptured cyst, treatment may also include removal of retained cyst contents and identifiable cyst-wall remnants when feasible.

LASER-BASED PROCEDURES

CO₂ LASER ABLATION / EVAPORATION

CO₂ laser ablation removes tissue through controlled vaporization, allowing the depth and extent of treatment to be adjusted according to the lesion and anatomic location.

How it is used:

Controlled ablation or evaporation of selected benign and premalignant skin lesions
Precise treatment of individual lesions and skin growths
Coagulation and hemostasis during tissue removal
Treatment of lesions in facial and other cosmetically sensitive areas
Treatment of multiple superficial lesions when appropriate

CO₂ laser ablation is used for selected lesions in which tissue destruction rather than surgical excision is the treatment objective. The treated surface heals through re-epithelialization. Treatment depth and technique are adjusted according to the lesion, location, skin characteristics, and treatment goal.

NON-ABLATIVE LASER PROCEDURES — VASCULAR LESIONS

elected vascular skin lesions can be treated with non-ablative vascular lasers that target hemoglobin within abnormal blood vessels, causing the treated vessels to coagulate, shrink, and gradually disappear.

Used for:

Cherry angiomas
Selected pyogenic granulomas
Other selected superficial vascular lesions

The laser and treatment parameters are selected according to the type, size, depth, and location of the vascular lesion. Depending on the lesion and laser used, temporary redness, bruising, swelling, or mild crusting may occur during healing.

IMPORTANT CONSIDERATIONS & POST-PROCEDURE CARE

Proper post-procedure care is an important part of wound healing and the final surgical outcome. Instructions are tailored to the type of procedure, treatment location, wound closure, and individual healing considerations.

SCARRING AND HEALING EXPECTATIONS

All surgical and ablative skin procedures heal through scar formation and tissue remodeling, although the final appearance varies considerably depending on the procedure and treatment area.

Factors affecting healing and scar appearance include:

Type and depth of the procedure
Size and location of the treated area
Skin tension and movement
Individual healing characteristics
History of hypertrophic or keloid scarring
Wound care during recovery
Friction, trauma, or excessive activity during healing

Careful surgical technique, proper wound care, and appropriate follow-up support favorable healing, but scar appearance cannot be predicted or completely controlled.

Patients are given procedure-specific instructions for wound care, activity, and protection of the treated area during recovery.

AFTER EXCISION OR SUTURED WOUND CLOSURE — RISK OF DEHISCENCE

Removal of external sutures does not mean that the surgical wound is fully healed. The skin may appear closed while deeper tissues remain significantly weaker and continue to regain strength over the following weeks and months.

Depending on the procedure, wound size, location, and degree of tension, restrictions on heavy lifting, strenuous exercise, repetitive movement, and other activities that stress the surgical area will continue after sutures have been removed.

Returning to unrestricted activity too early can cause wound dehiscence (partial or complete reopening of the surgical wound), scar widening, and excessive scar formation.

Specific wound-care and activity instructions are provided for each procedure, including guidance on when normal activities and strenuous exercise can be safely resumed.

YOUR ROLE IN PROPER HEALING

The procedure itself is only the beginning of the healing process. What happens after surgery has a significant effect on wound healing and the final outcome.

Careful surgical technique and proper wound closure provide the foundation for healing, but the surgical area must then be protected from excessive tension, movement, trauma, moisture, and other stresses during recovery.

Proper healing requires active patient participation:

The procedure and wound closure are performed by the physician
The patient protects and cares for the surgical area throughout recovery

Following wound-care instructions, maintaining dressings as directed, limiting activity for the recommended period, and protecting the surgical site are essential to reduce the risk of infection, wound dehiscence, delayed healing, scar widening, and excessive scarring.

Suture removal does not end the patient's role in wound protection. Activity and wound-care restrictions must be followed for the period recommended by the physician, even after the surface of the wound appears healed.

Specific post-procedure instructions are provided according to the procedure and surgical location.

Skin Surgery Evaluation

A skin surgery evaluation helps determine the diagnosis, treatment options, and most appropriate procedural approach for the lesion being treated.

📞 Call (847) 518-9999 to schedule a skin surgery evaluation.

Medical Disclaimer
This information is provided for educational purposes only and does not replace individualized medical evaluation. Treatment recommendations depend on clinical findings, diagnostic requirements, and patient-specific factors. Outcomes may vary, and no specific medical or cosmetic result can be guaranteed.

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