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Office Surgery

Posted May 14, 2019 in Plastic Surgery

Many people are hesitant to schedule surgery because they are anxious and do not know what to expect, sometimes resulting in their condition to worsen over time. To try to ease some of those concerns, I am going to walk you through a typical in-office excision procedure so you can be educated and prepared when you come to see us at Mountcastle Plastic Surgery.

First, you will meet with one of our warm caring nurses and she will review your medical history and ask what brought you in. Most of the time it is for a skin lesion, skin cancer, or mass removal. The nurse will feel it, look at it, and get a picture for your chart. If you decide to do surgery the same day, which most of our patients do, the nurse will go over the procedure and have you sign your consent form. We also pull your benefits beforehand so we can review your estimated out of pocket cost for the procedure. We like for our patients to know what they will be financially responsible for before surgery because no one likes getting a surprise bill in the mail.


Dr. Mountcastle will come in, introduce himself, and get to know you as he reviews your chart. Once he has listened to your goals and thoroughly assessed the area he will decide what the best surgical plan is for you. Sometime he will order a radiology scan prior to doing the surgery, or sometimes, if the mass is too large we will schedule the procedure for another day when he has more time. Dr. Mountcastle first cleans the area with a cleaning solution and then covers the area with a sterile drape. After that Dr. Mountcastle will numb the area with some lidocaine (this will be the only part you feel) after this ‘bee sting’ he will test to make sure you are completely numb. If you feel anything at all he will add more numbing medicine. Once you are numb he will make an incision to remove the lesion or mass, sometimes you may feel some pressure but there should be no pain. Dr. Mountcastle makes the smallest incision possible to reduce the size of the scar. Obviously, with any incision there will be a scar but Dr. Mountcastle specializes uses special cutting and sewing techniques to reduce the appearance and size of the scar. Sometimes he is able to hide the scar in a patient’s natural lines and wrinkles depending on the location. After he has removed the lesion we will make sure it gets sent off to pathology for testing to find out exactly what it is and you will get these results when you come back to get your sutures out. Typically when you have an excision on your face you will have the suture in for 5-7 days and 10-14 days if the excision is located on the body. You will leave the office with a paper bandaid on top of the sutures to keep the wound clean as it heals. We apply a special medical sticky glue called mastisol which helps keep the bandaid or steri strip on until you come back to get the sutures removed. If Dr. Mountcastle is removing a large mass he will wrap you in gauze and tape or an ace wrap for 24-48 hours depending on location and size.

Post care

Typically, you can shower 24 hours after the procedure. Make sure when you wash you let the soapy water run over the wound, do not scrub, or try and clean the area. Once you are done showering, pat the area dry with a clean towel so you do not irritate the wound. Like I said before, the bandaid/steri strip we put on should stay on until you come back to get your sutures removed but if it falls off just cover it with another bandaid, no worries. You can start to exercise after 24 hours as well, just make sure you are not doing anything that puts tension on the wound. Also, listen to your body, if you are in pain or feel like you are pushing yourself cut back on the exercise and ease your way back into it. Keep in mind when you have sutures in you cannot soak in water, that means no baths, no pools, no hot tubs. Obviously everyone is different so post-op instructions may vary from patient to patient but one of our nurses will write down your specific instructions so you do not forget.

Scar cream

We highly recommend applying scar cream to the excision site after the sutures are removed and the area is completely healed. We sell a scar cream in our office called Biocorneum, this product has silicone and SFP in it which are the 2 main ingredients you want in scar cream. So if you do not get it with us make sure you are reading the ingredients before you purchase one. If you get scar cream without SPF it is good to apply a layer of SPF on top of the cream/ scar. The sun and scars are NOT friends. You will apply the scar cream 1-2x a day for 3 months until the bottle is gone, or until you are happy with the look of the scar. We sell 2 sizes depending on how large your excision site is. Many of our patients that have used Biocorneum have had great results, some will come back to buy more just to keep around the house for when the kids or other family member have scars they want to treat.

Dr. Mountcastle is always available to his patients after hours and weekends. The instructions on how to get in touch with him will be on your post-op instructions which you will get the day of your consultation or surgery. This puts patients at ease knowing they can get in touch with him at any time if they needed to. Feel free to reach out to our office if you have any other questions.

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