Cyst Removal: What to Expect After Surgery

Surgical excision of a sebaceous cyst?

Hello, doctor.
In September 2017, I developed a cyst on my face that resembled a sebaceous cyst.
Initially, I went to a general dermatology clinic where they made an incision to drain it, but it was ineffective, and the swelling persisted.
Later, at the end of 2017, I visited Cheng Kung University Hospital, where I received an injection of a substance similar to steroids, which helped reduce the swelling for about a year without recurrence.
My face returned to its pre-cyst appearance until September 2018, when it swelled up again.
Although the steroid injections helped reduce the swelling, it recurred after a month.
Currently, I received an injection in November, which reduced the swelling, but my face has become indented.
I consulted a doctor who said there is nothing inside at the moment, and if I want surgery, it is recommended to wait until it recurs.
I would like to ask if surgery would cause further indentation on my face (I am very concerned about the current indentations).
Will the scars from the surgery be very noticeable? I have not found any postoperative photos online for reference, which has made me hesitant to proceed with surgery, leading me to continue with steroid injections (I have had a total of three injections from September to November).

Elvin, 20~29 year old female. Ask Date: 2019/01/09

Dr. Wu Yuxin reply Dermatology

There will definitely be scars after surgery, but it is necessary to eliminate the issue.

Reply Date: 2019/01/09

More Info

When considering cyst removal surgery, particularly for a cyst that has been persistent and recurrent, there are several factors to keep in mind regarding what to expect post-surgery, potential outcomes, and recovery.

Understanding Cyst Removal Surgery
Cysts, such as epidermoid cysts (often referred to as "sebaceous cysts"), can be frustrating due to their tendency to recur if not completely excised. The surgery typically involves making an incision over the cyst, removing the entire cyst sac, and closing the incision. If the cyst is not completely removed, there is a significant chance that it will return.

Post-Surgery Expectations
1. Recovery Time: After the surgery, you can expect some swelling and bruising around the incision site. This is normal and should subside within a few days to weeks. Most patients can return to their normal activities within a week, but it’s essential to follow your surgeon's specific post-operative care instructions.

2. Scarring: Scarring is a common concern for many patients. The visibility of the scar will depend on various factors, including the size of the incision, the surgical technique used, and your skin type. Surgeons often aim to place incisions in less visible areas or along natural skin lines to minimize scarring. Over time, scars typically fade and become less noticeable.

3. Skin Indentation: Regarding your concern about potential indentation or a "dented" appearance after surgery, this can occur if the cyst was large or if there is significant tissue removal. However, if the cyst is excised properly, and the surrounding tissue is handled carefully, the risk of indentation can be minimized. Discussing your concerns with your surgeon can help them plan the surgery to achieve the best cosmetic outcome.

4. Post-Operative Care: After surgery, it’s crucial to keep the incision clean and dry to prevent infection. Your surgeon may provide specific instructions on how to care for the wound, including when to change dressings and signs of infection to watch for.

5. Follow-Up Appointments: Regular follow-up appointments are essential to monitor healing and address any concerns. If you notice any unusual changes, such as increased swelling, redness, or discharge, contact your healthcare provider immediately.

Decision to Proceed with Surgery
Given your history of recurrent cysts and the ineffectiveness of steroid injections, surgery may be a viable option. While steroid injections can reduce inflammation and temporarily shrink the cyst, they do not eliminate the cyst itself, which is why recurrence is common.
If you are hesitant about surgery due to concerns about scarring or indentation, it’s important to have an open discussion with your surgeon. They can provide you with realistic expectations based on your specific case and may even show you before-and-after photos of similar procedures they have performed.

Conclusion
In summary, cyst removal surgery can provide a long-term solution to recurrent cysts, but it is essential to weigh the benefits against potential cosmetic outcomes. Scarring and indentation are valid concerns, but with proper surgical technique and post-operative care, these can often be minimized. Ultimately, the decision to proceed with surgery should be made in consultation with your healthcare provider, who can guide you based on your individual circumstances and medical history.

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