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Formerly Groot DermaSurgery

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Sebaceous Cyst Removal

In this video Dr. Nakatsui is removing two sebaceous cysts located on the scalp. Our lovely patient graciously allowed us to film the procedure and we thank you for that!

In this video the two cysts come out relatively easily and intact as a whole. There will be several instances where we are not so lucky and the cyst may fragment or it may adhere to surrounding tissue more making extraction more difficult.

Sebaceous cysts may occur anywhere on the body at any time of our lives. They are generally not life-threatening, but when concerned about any lesion, it is always best to seek medical attention. Many patients with sebaceous cysts may leave them as they generally will not bother them. From time to time, cysts may become inflamed, painful, produce discharge, or become infected. If a cyst has had repeated infection/inflammation or self attempts to extract the contents by squeezing the cyst, this is when the cyst wall may become more adherent to surrounding tissue making it difficult to extract.

Should a cyst develop, it is advisable not to perform self surgery as any tools used to puncture the skin or extract the cyst may push unwanted bacteria into the site causing an infection. Not only that, if the wound site is not properly closed or should become infected, when it fully heals you may be left with an unwanted scar which may be difficult to treat in the future.

Nanosecond pulsed electric field treatment of sebaceous hyperplasia

At Nakatsui DermaSurgery, sebaceous hyperplasia are most commonly treated with the CO2 resurfacing laser. A recent study on a new treatment modality was published in Dermatologic Surgery on the use of nanosecond pulsed electric field therapy. Each sebaceous hyperplasia lesion was treated 1-2 times. Ninety percent of lesions cleared with electric field therapy. With respect to pain, 54% reported mild pain, whereas 15% reported moderate pain with treatment Patients did experience hyperpigmentation although this gradually faded with time. At day 60, 45% of lesions were hyperpigmented. Redness and swelling were noted initially but did nor persist. One of the persistent side effects was that of small depressions at 19% of treatment sites.

This is an interesting new technique for treatment of sebaceous hyperplasia. Whether it will replace the use of CO2 resurfacing remains to be seen. Find out more about sebaceous hyperplasia.


Safety and Efficacy of Nanosecond Pulsed Electric Field Treatment of Sebaceous Gland Hyperplasia. Munavalli GS, Zelickson BD, Selim MM, Kilmer SL, Rohrer TE, Newman J, Jauregui L, Knape WA, Ebbers E, Uecker D, Nuccitelli R. Dermatol Surg. 2020 Jun;46(6):803-809.

Clean Cyst Removal

Sebaceous Cyst Removal

In this video, Dr. Nakatsui removes a sebaceous cyst from our patient’s scalp. The cyst came out whole, cleanly, and intact! Many times, if a cyst becomes infected it can adhere to the surrounding tissue making extraction trickier as it can fragment and stick to surrounding tissue.

Overall a great little surgery which great end results!

Benign Cysts and Growths

skin tags and other benign lesions (cysts, seborrheic keratoses, and sebaceous hyperplasia, milia)

Skin tags, sebaceous hyperplasia, seborrheic keratoses, milia, sebaceous cysts, and syringomas are a few of the very common benign growths that people get as they age.

Our skin is the largest organ of the body and is subjected to many internal and external abuses. So it is not surprising that over time the skin develops a variety of innocent lumps and bumps, some of which may be cysts and growths. These lumps and bumps are many and varied, and are often tagged with long medical names that are impossible to pronounce. Suffice it to say that you do not have to live with white, brown, or red appendages that may protrude from your skin. They are usually easy to remove, particularly now that target specific lasers have been developed. Common benign lesions that are not pre-cancerous or cancerous may include: acrochordons (skin tags), milia, seborrheic keratoses, syringomas, sebaceous cysts, and sebaceous hyperplasia.

Benign cysts and growths such as skin tags and seborrheic keratoses are considered to be cosmetic in nature therefore removal of these lesions is the responsibility of the patient. The cost varies on the type of lesion, the number of lesions, and the treatment recommended.

Frequently Asked Questions (FAQ) About Skin Tags, Sebaceous Hyperplasia, Milia, Sebaceous Cysts, and Seborrheic Keratoses


What Are Skin Tags?

“Skin tags” perfectly describes the little lesions that grow out from the skin. Skin tags are usually the same colour as the surrounding skin although they may be lighter in colour or may be slightly pigmented giving a tanned appearance. The medical term for a skin tag is achrochordon. The skin has a tendency to grow in the direction of stress so skin tags develop in areas of multi-dimensional movement such as the armpits, groin, and around the neck.

This is because the skin does not “know” which way to grow so it simply grows out. The tendency to develop skin tags is inherited. They are harmless and never become cancerous or malignant. At times, a skin tag may become sore from rubbing against clothing or jewelry. While annoying, there is no reason for concern.

skin tag removal treatment edmonton

Can Skin Tags Grow Back Once Removed?

Skin tags usually do not grow back once removed. However, it is possible that new skin tags can appear in the same area where one was previously removed.


How Are Skin Tags Removed?

Skin tags are also known as acrochordons. They are completely harmless and are treated only if a person finds them to be cosmetically unacceptable or a nuisance. Acrochrodon removal is a simple office procedure. They may be frozen with liquid nitrogen, snipped off with surgical scissors, or removed with the carbon dioxide resurfacing laser. The CO2 resurfacing laser is the treatment of choice because it blends the treatment site into the surrounding skin resulting in a more cosmetically pleasing result and it makes recurrence less likely. Healing is usually complete in a week or two. New skin tags may form even if all existing tags are removed. There’s no way of preventing them. Obesity, tight clothing, necklaces, and other items that encourage friction will make skin tags more likely to appear.

Can Toothpaste Remove Skin Tags?

There are all sort of unapproved agents that people use to try and remove skin tags from toothpaste to crushed garlic to wart remover and nail polish. It’s probably best to see your dermatologist to decide on the best way to remove your skin tags.

What Are Milia?

Milia are common, harmless, miniature oil gland cysts which can appear anytime during life. They may occur when the pores become plugged with creams, but may also occur on their own.

Milia never become malignant. They can become larger, and sometime become annoying because of their cosmetic appearance, but do not present any concern medically.


How Are Milia Treated?

Milia are usually removed with gentle electrodesiccation or, in the case of larger lesions; they are vaporized with the carbon dioxide laser. To prevent milia avoid the use heavy creams which plug up the pores.

What Are Seborrheic Keratoses?

Seborrheic keratoses are harmless, common skin growths that may first appear during adult life. As time goes by, more growths can appear. Some people have a very large number of them. Seborrheic keratoses may appear on both covered and uncovered parts of the body; they are not caused by sunlight. The tendency to develop seborrheic keratoses is inherited.

Seborrheic keratoses never become malignant. They begin as slightly raised, light brown, red or white spots. They gradually thicken and take on a rough, wart-like surface and with time they may slowly become darker and may turn black. These color changes are harmless. Seborrheic keratoses are superficial and look as if they were stuck on the skin.

seborrheic keratosis dermatology

How Are Seborrheic Keratoses Treated?

Seborrheic keratoses can easily be removed. Surgery (scraping), liquid nitrogen sprays and lasers are the treatments of choice. We use the Ultrapulse carbon dioxide resurfacing laser and the PicoWay laser to treat seborrheic keratoses. The only reason for removing a seborrheic keratosis is your wish to get rid of it because it is unsightly, itches or annoys you by rubbing against your clothes.
seborrheic keratosis

What Are Syringomas?

Syringomas are benign tumors of the sweat ducts, which appear most commonly on the neck, chest and face, particularly under the eyes. They may vary in color from translucent or skin colored, through the yellow spectrum, to a purplish shade. They may be round or flat, and can range in size from 1 to 5 mm. Syringomas commonly appear during adolescent and may increase in number into adulthood.

How Are Syringomas Treated?

Excision was the treatment of choice in the past, although a small scar was unavoidable. Now syringomas can be easily vaporized with a CO2 laser. To avoid a dent in the skin, the cyst is not always entirely removed; therefore recurrence is common. Asymptomatic in nature, they are usually removed for cosmetic reasons.

What Are Sebaceous Cysts?

A sebaceous cyst forms when an oil gland ruptures in the second layer of the skin and becomes surrounded by scar tissue. These dome-shaped protuberances commonly appear in groups on the skin but may be solitary. They enlarge slowly and may become inflamed and tender from time to time.

Pilar cysts are similar to sebaceous cysts. They appear in multiples on the scalp and are common in families.


How Are Sebaceous Cysts Treated?

Cysts are usually excised with or without CO2 laser surgery. The cyst is anesthetized prior to removal so no pain is felt during the procedure. Once the treatment is complete the treatment site may be swollen, bruised and tender to the touch for several days.

What Are Sebaceous Hyperplasia?

Sebaceous hyperplasia are common, harmless skin growths that usually appear in adult life. Sebaceous hyperplasia are primitive oil gland growths that are much like icebergs; that is, we see the top part of them, but they are considerably larger under the skin. Sebaceous hyperplasia never become malignant. The lesions begin as slightly raised, yellowish or milky colored lesions with a central dimple, giving them a crater-like appearance. Gradually they thicken and become larger. They are not dangerous and do not require treatment, although we treat many patients for these lesions if they do not like the appearance of them. Some people are fortunate but others can can develop many on their face through no fault of their own.

How Are Sebaceous Hyperplasia Treated?

Sebaceous hyperplasia treatment consists or removing them or vaporizing them with a carbon dioxide resurfacing laser. After removal, the treatment site is raw and red. It may take several months for the redness to fade. After seven days, make-up can be applied to cover the redness until it fades. Sebaceous hyperplasia may return or push to the surface requiring another treatment. In general, sebaceous hyperplasia are not treated by excision because it might leave an unsightly scar. Electrodessication can also be tried but the carbon dioxide laser is a more precise method of ablating these benign yet common skin lesions.

Other traditional treatments include cryosurgery, electrodessication, curettage, topical trichloroacetic/bichloroacetic acid and shave excision. There are also some experimental modalities such as nanosecond pulsed electric field treatments.

Do you have another question that wasn’t addressed here? Please feel free to contact us with any questions or concerns you may have!


acne clinic edmonton treatment

Acne vulgaris is an extremely common condition that affects teenagers, adults, and sometimes even infants (baby acne). Although this condition is most common in teenagers, it can appear in adults as well, especially in women along the jawline. It can also occur on the back (back acne or “bacne”) or chest. It is characterized by different types of blemishes like papules, pustules (pimples), comedones (whiteheads and blackheads), and sometimes cysts.

Cystic acne is one of the more severe forms as it is the most likely to leave permanent scars. Cystic acne often means that more aggressive treatment like Accutane is warranted and that laser treatment may be needed to address acne scars. Learn more about the different types of acne scar treatments.

Typical areas of involvement are the face (forehead, chin, cheeks, and nose), chest, back, and arms. Although extremely common, even mild cases can be unsightly and can be damaging to one’s self-esteem and emotional well-being. The most troublesome aspect of this condition is the potential for scars to occur, especially with cystic acne, as this can be extremely difficult to treat in some cases. Our dermatologist-led Edmonton acne clinic can address your pimples and blackheads, as well as acne scarring.

What causes acne?

This condition is caused in part by a bacteria called Cutibacterium acnes (previously called Propionibacterium acnes). This bacteria helps to clog pores leading to an accumulation of sebum, which in turn causes inflammation. Other factors such as makeup, stress, heredity, diet, lifestyle, friction, and hormones can also contribute to clogging your pores.

Who gets acne?

  • 80% of adolescents
  • 25% of adults aged 20-40
  • 75% of adult cases are in women (likely because of hormones)

Treatments For Active Acne

How to get rid of acne

Getting rid of acne is not always easy. Treatment can be broken down into internal treatments and external treatments. Internal treatments include medications such as oral antibiotics, birth control pills. and Accutane, while external treatments include topical antibiotics, laser, Morpheus8 RF microneedling, Isolaz, and photodynamic therapy (PDT).

At our dermatoloigst-led Edmonton acne clinic, we first treat patients with active acne using a step-wise approach, depending on severity. If mild, we can start with a topical antibiotic, or a topical retinoid like tretinoin if the patient has comedones (whiteheads and blackheads). Some examples of commonly used topical medications include Tactupump Forte and Biacna. If more severe, we can use oral antibiotics like tetracycline, doxycycline, minocycline, and erythromycin, or birth control in women. Some women will respond to medications that block the testosterone receptor such as spironolactone. Some other popular treatments include chemical peels, HydraFacial MD, blue light, radiofrequency microneedling (Morpheus8), or laser.

acne treatment clinic edmonton

If you just have one spot, our doctors can do a spot treatment with a tiny injection of cortisone to clear that spot in many cases. However, care must be taken to avoid injecting too much cortisone to avoid indenting the skin.

If very severe (e.g. cystic acne), we will often use Accutane, Clarus, or a new version called Epuris. Epuris, Clarus, and Accutane are very similar as the active ingredient in all of these is isotretinoin, but Epuris has one major advantage–it can be absorbed without taking it with a fatty meal (which is the ideal way to take Accutane). The problem with Accutane and Epuris is that they have a list of potentially significant side effects, which include birth defects, extreme dryness, elevated cholesterol and triglyceride levels, and depression. Despite theses risks, it is often prescribed for persistent cases and for cystic acne.

Other treatment options for active acne

  • Fractora is a fractionated radiofrequency (RF microneedling) treatment that our dermatologist uses to help decrease acne and help treat scars as well. This treatment uses radiofrequency to reduce sebum production.
  • Morpheus8 is our newest treatment for acne. It is the new, improved version of Fractora, yielding even better results with less discomfort. It reduces sebum production and kills the causative bacteria. As a side benefit, it also helps with acne scarring.
  • Chemical Peels can be used in some patients.  The exfoliation caused by the chemical peel would frequently improve the condition although there are some patients whose skin condition worsens as a result of irritation. Discuss this with Dr. Smith or Dr. Nakatsui before proceeding with therapy.
  • HydraFacial MD treatments can also help. It simultaneously exfoliates, removes impurities, and rehydrates your skin. We have had a lot of success using this modality.
  • Isolaz is a device that uses a combination of suction and light therapy to kill acne bacteria and clear pores. This is not strictly speaking laser treatment as it uses intense pulsed light to treat the skin. This decreases the number of lesions and the amount of sebum produced. We did use this on our patients for awhile and found it effective for some people. Although Isolaz can be effective, we no longer offer this therapy because we were not able to sterilize the tips between use and if we used new tips for every treatment, it made treatments too expensive for the patient.
  • PDT is an effective therapy that uses a special wavelength of light to activate a topical medication that is absorbed by acne-causing bacteria to clear the bacteria and treat the acne. One of the downsides of PDT therapy is that it may cause redness and peeling, which could last up to one week following therapy.
  • Pulsed dye laser can sometimes be used to treat acne. It works through photochemical effects on Cutibacterium acnes and photomechanical effects on sebaceous glands and microvasculature.

Acne can also leave unsightly scarring. Fortunately, there are many treatments available to treat acne scarring at Nakatsui Dermasurgery (formerly Groot DermaSurgery). Learn more about your scar treatment options here.

Frequently Asked Questions


What is Maskne?

Maskne is a colloquial term for the development of acne in areas covered by a mask. This has become very common with face mask precautions during the Covid-19 Coronavirus pandemic. Many people are suffering from pimples developing under the areas covered by their mask.

In some people, this represents a type of acne mechanica where rubbing stimulated the development of pimples. Athletes often see this in areas of rubbing such as with chinstraps. This same process can affect mask wearers. In others, the acne-like outbreak is probably perioral dermatitis bought on by irritation from the mask.

Perioral dermatitis is a condition where blemishes develop as a result of skin irritation. As a result, people with sensitive skin are more likely to develop this. This irritation can cause similar rashes around the nose (perinasal dermatitis) and around the eyes (periorbital dermatitis). Treatment for this involves removing the irritants and may involve the use of oral and topical antibiotics. With maskne and COVID, it will be impossible to eliminate the use of masks but using a mask that is clean and less abrasive will help.

perioral dermatitis acne

Is Accutane Use for Acne Associated With Inflammatory Bowel Disease?

The potential association between isotretinoin use (such as Accutane, Clarus, or Epuris) for acne and inflammatory bowel disease (IBD) such as ulcerative colitis and Crohn’s disease is controversial. Some studies have suggested there may be an association whereas others have concluded there is no association.

One of the most recent studies was published in 2021 and looked at 27230 patients on isotretinoin and 631089 control patients who were not on isotretinoin. The researchers found the incidence of IBD in patients exposed to isotretinoin was very low and they could not find any evidence of increased risk versus the control population. At this point, the risk of developing IBD from isotretinoin appears to be very low if it there is even a true association at all.