Sebaceous cysts are formed by the glands at the base of a hair follicle. The typically form a capsule around some foul smelling collection of keratin (dead skin cells). The important thing is that they are immediately beneath the surface of the skin. Except for those in the nape of the neck, which has very dense connective tissue surrounding it, they are usually freely mobile to movement. Their removal involves making a very careful incision through the upper layer of the skin down to but not into the cyst wall, (I accomplished this about 85% of the time. Then one needs to dissect the surrounding tissue from the surface of the cyst, again trying not to rupture the cyst. If it does rupture, aside from the smell, the removal is slightly more technically difficult.
There is a relatively poor blood supply to the cyst itself, which thus does not bleed very much. Because of inflammation, the sides and base of the cyst may be in contact with more vascular tissue, which will bleed more easily. Usually the injection of the anesthetic agent with adrenaline causes enough vasoconstriction to reduce bleeding. Any bleeding that does occur is EASILY controlled with pressure and electric cautery. Although expensive, rather than use the large “Bovie” cautery, many times a disposable ophthalmic cautery (large size) does an easy and excellent job of ‘cooking’ any significant bleeding vessels.
The removal of a cyst is a simple procedure, but then again there are competent and not so competent doctors. Sorry if I offend some of my family practice colleagues, but they do not have usually the breadth of skills and judgment to do a good job in an anticoagulated patient. Likewise, almost any surgeon should be able to do a careful closure that will give affine scar and cosmetic result. Because there is an underlying defect (where the cyst leaves a hole) the incision should be closed in two layers. Using absorbable suture the subcutaneous layer is brought together which closes the hole. The small (called 5-0 sutures are used in the skin itself the hold the edges in approximation. Because of the subcutaneous sutures taking the strain of the tissue trying to pull apart, there is little strain on the skin edges themselves, which contributes to reducing scar formation.
Bottom line; any of plastic, general, or ENT surgeon should do a good job. You want to make your appointment specifically for removal of a cyst.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
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