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Razor surgery: Simple tool yields predictable results


In an era of costly lasers and high-tech cosmetic procedures, dermatologists shouldn't forget that the lowly disposable razor also can produce spectacular results, an expert says.

Key Points

New York - As cosmetic surgical technology continues to advance, it's easy to lose sight of the role of low-tech surgical tools such as the standard disposable razor, which provides excellent cosmetic results in a variety of situations, an expert says.

"We live in an era of exploding technology, and people are mesmerized by high technology, such as lasers," says Nia Terezakis, M.D., a New Orleans dermatologist in private practice, and clinical professor of dermatology, Tulane Medical School and Louisiana State University.

However, she says, "One doesn't need high tech to get beautiful results. We can still make patients very happy without a laser."

"Many of those men don't have great health, or they're on aspirin or Coumadin (crystalline warfarin sodium, Bristol-Myers Squibb), which makes them prone to bleeding," Dr. Terezakis tells Dermatology Times.

However, she says with razor blade surgery, one can shave down a lumpy, bumpy nose a little bit at a time under local anesthesia.

This way, Dr. Terezakis says, "It's very easy to stop the bleeding. And procedures can be staged so that patients are not under anesthesia or sedation for a long time."

Additionally, she says many of her patients are busy executives who don't want the two to three weeks' downtime that more extensive cosmetic procedures can require, but they do want predictable results.

"They want to know what it's going to look like or how long it's going to take to heal," she says.

Dr. Terezakis' technique involves breaking a double-edged razor in half and using each resulting blade for three to four carvings to ensure she's always working with a sharp edge.

"Razor blades come already sharpened and sterilized. They're easy to break in half and don't require a special handle - you can just hold it between your thumb and forefinger," she says.

Curving the blade too much will yield a concave scar, Dr. Terezakis says.

"So, hold it as straight as possible, or just barely curve it so the plane of excision is level with the surrounding skin," she says.

If the cut leaves an indentation, Dr. Terezakis uses an electric needle with a very low current to feather the edges.

"If you use a very hot instrument to burn the edges, it can produce a white scar. So, I try to use as little current as possible - I basically set my machine on zero," she says.

Similarly, she avoids using an electric needle to stop bleeding in patients taking anticoagulants, due to the risk of scarring.

Rather, Dr. Terezakis says, "Sometimes, I'll use Gelfoam (Pfizer), aluminum chloride or Monsel's solution (ferric sulfate) to stop the bleeding."

Hot cautery represents a possible alternative to razor surgery, but she avoids this technique as well.

"Many of my patients have a lot of sun damage, resulting in a beefy, red face. And if you use cautery or a Bovie blade (Aaron Medical), you risk the nose not being the same color as the rest of the face afterward," Dr. Terezakis says.

With practice and patience, there's virtually no limit to the size of defect one can treat with razor surgery, Dr. Terezakis says.

"If you start doing a little at a time," she says, "you essentially teach yourself how to use it."

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