SEBACEOUS HYPERPLASIA

CLINICAL OVERVIEW & PROCEDURAL MANAGEMENT

Sebaceous hyperplasia is a benign condition caused by enlargement of sebaceous (oil) glands. It most commonly appears as small, soft, yellowish or flesh-colored bumps on the face, particularly the forehead, cheeks, and nose.

These lesions are not harmful, but they may increase in number over time and are frequently mistaken for other skin growths. Because sebaceous hyperplasia originates from deep glandular structures, treatment requires careful technique selection to balance effectiveness with cosmetic outcome.

CLINICAL EVALUATION

Evaluation begins with focused clinical examination and, when appropriate, dermoscopic assessment. Key factors considered include:

• Lesion size, depth, and number
• Distribution and anatomic location
• Stability versus progression
• Skin type and healing characteristics
• Diagnostic certainty

While many lesions have a classic appearance, some require additional evaluation to confirm diagnosis before treatment is selected.

SEBACEOUS HYPERPLASIA VS. BASAL CELL CARCINOMA

Sebaceous hyperplasia and basal cell carcinoma (BCC) can occasionally appear similar on visual inspection, particularly when lesions are:

• Flesh-colored or yellowish
• Located on sun-exposed facial skin
• Slowly enlarging

Sebaceous hyperplasia is benign and does not behave like skin cancer.
When appearance is atypical or diagnostic certainty is needed, medical evaluation—and in select cases biopsy—helps ensure accurate diagnosis before treatment.

WHY SEBACEOUS HYPERPLASIA IS DIFFICULT TO TREAT

Sebaceous hyperplasia is challenging to treat because the visible surface bump represents only part of the lesion. In many cases, the enlarged sebaceous gland extends deep beneath the skin surface.

Key reasons treatment can be difficult include:

• Deep glandular components beneath the visible lesion
• Risk of scarring with aggressive destruction
• Incomplete removal does not guarantee permanence
• New lesions may develop over time due to ongoing sebaceous activity

For these reasons, treatment focuses on control and cosmetic improvement, often using staged or combination approaches rather than a single definitive procedure.

TREATMENT OPTIONS IN GENERAL

Sebaceous hyperplasia can be managed using several procedural and energy-based approaches. No single treatment is universally curative, and recurrence or development of new lesions is common over time.

Procedural / Destructive Options

• Punch excision
  • Complete removal of individual lesions
  • Allows histopathologic confirmation
  • Leaves a small linear scar
  • Best for solitary or diagnostically uncertain lesions
• Shave removal
  • Removes raised portion only
  • Faster healing but higher recurrence risk
  • Possible in select cases; not a preferred method at IVSI
• Electrosurgery / electrodessication
  • Commonly used in general dermatology
  • Not offered at IVSI due to higher risk of scarring and dyspigmentation, particularly on facial skin
• Cryotherapy (freezing)
  • Variable effectiveness
  • Not offered at IVSI due to risk of hypopigmentation, scarring, and unpredictable healing on the face
• CO₂ laser ablation
  • Precise tissue vaporization
  • Reduced procedural bleeding
  • Recurrence possible due to deep gland component

LASER & ENERGY-BASED OPTIONS

These methods may reduce lesion prominence or sebaceous activity but rarely eliminate glands entirely.

• Pulsed Dye Laser (PDL)
  • Targets vascular support to sebaceous glands
  • Typically adjunctive rather than definitive
• Other vascular or non-ablative lasers
  • Variable benefit
  • Often used as part of staged treatment
• Fractional resurfacing lasers
  • Improve overall skin texture
  • Not a primary treatment for gland removal

TREATMENT OPTIONS OFFERED AT IVSI

At IVSI, treatment selection is individualized based on lesion size, depth, location, skin type, diagnostic certainty, and patient goals. Only methods that balance precision, safety, and predictable healing are offered.

PUNCH EXCISION (SELECT LESIONS)

• Used for large, solitary, or diagnostically uncertain lesions
• Allows complete removal and histopathologic evaluation when needed
• Requires sutures and results in a small linear scar that typically fades over time

CO₂ LASER ABLATION / EVAPORATION

• Used for multiple or raised lesions
• Allows controlled tissue removal with minimal bleeding
• Does not always eliminate the deep gland component
• Recurrence or development of new lesions may occur over time

PULSED DYE LASER (PDL) / Nd:YAG 1064 — ADJUNCTIVE

• Used to reduce vascular support to sebaceous glands
• Non-ablative
• Typically part of a staged treatment plan
• Not a stand-alone treatment for lesion removal

FRACTIONAL RESURFACING LASERS (SELECT CASES)

• May be used after lesion removal to improve texture and blending
• Not a primary treatment for sebaceous hyperplasia

In many cases, staged treatment is recommended to achieve the most balanced cosmetic outcome. Additional resurfacing or rejuvenation procedures may be considered once healing is complete.

ADJUNCTIVE MEDICAL THERAPY (LIMITED ROLE)

Topical retinoids (such as tretinoin) may be recommended in select patients to support epidermal turnover and help reduce prominence of new lesions over time.

Topical therapy does not remove established sebaceous hyperplasia lesions and is considered supportive rather than definitive.

IMPORTANT CONSIDERATIONS

• Complete and permanent removal of all sebaceous glands is not always possible
• Recurrence or development of new lesions is common
• Aggressive treatment increases scarring risk
• Careful technique selection is essential, especially on facial skin

MEDICAL VS. COSMETIC CARE

Sebaceous hyperplasia is a benign condition. Treatment is most often performed for cosmetic reasons unless diagnostic uncertainty is present.

When lesion appearance is atypical or diagnosis is uncertain, biopsy or excision may be medically indicated. Cosmetic treatments are discussed separately, with clear expectations regarding outcomes, recurrence risk, and insurance coverage.

Learn more about our approach to Skin Surgery & CO₂ Laser Procedures.

SCHEDULE AN EVALUATION

If you have facial bumps that are increasing in number, changing, or cosmetically concerning, professional evaluation is recommended.

📞 Call (847) 518-9999

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. Cosmetic outcomes and recurrence risk may vary.