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Surgical Dermatology in Syracuse, Rochester, and Ithaca, NY

Double board-certified Facial Plastic Surgeon Dr. Sang W. Kim of the Natural Face™ Clinics offer surgical dermatology for patients residing in the Syracuse metropolitan area and Central New York cities including, Ithaca, and Rochester.

Over the past few decades, there has been an increase in the incidence of skin cancer in the United States.  However, while there are more skin cancers being diagnosed, the survival rate has improved significantly.  This is due to an increase in awareness with screening and early diagnosis followed by timely and appropriate treatment of the disease.

We offer surgical dermatology services to our medical patients.  Many are referred by their primary care providers while others find us through their family and friends.  We treat patients who present with concerning skin lesions. Often, we can provide same day examination and/or biopsy of the lesion.  The confirmatory diagnosis of the excised skin lesions is made by the pathologists who examine the tissue specimen under the microscope with the assistance of special stain studies if necessary.

Routinely our practice has encountered patients who self-referred to our office for evaluation and treatment of skin lesions involving the face, head, and neck.  Over the past several years, we have streamlined our practice to accommodate an effective, convenient, and prompt care for patients with skin lesions.

Screening for Skin Lesions

Skin lesions are typically categorized into pigmented or non-pigmented lesions.  If a pigmented lesion is determined to be malignant, it is most likely a melanoma.  If non-pigmented lesions are determined to be malignant, the two most common types of non-melanoma skin cancer are basal cell carcinoma and squamous cell carcinoma.

While routine screening for skin cancer of the general population may not be practical, it may be prudent for careful assessment during an annual physical exam in patients with high risk for skin cancer.  These risk factors include current immunosuppressive therapy (example, organ transplant patients), personal history of skin cancer, first-degree relatives with melanoma, dysplastic nevus syndrome (100+ benign nevi or 5+ atypical nevi on exam), or history of radiation.  Symptoms including itchiness and tenderness have been associated with the non-pigmented lesions with skin cancers.  Patients frequently describe a non-healing lesion with intermittent bleeding.

Melanoma is classically described as a pigmented mole with ABCDE signs: asymmetric margins, uneven or irregular borders, several shades of colors, diameter > 6mm, and evolving or changing over time.

Surgical Dermatology in Syracuse, Rochester, and Ithaca, NY

Diagnosis

Skin biopsies are categorized into two types: incisional and excisional biopsy.  During an incisional biopsy, only a part of the lesion is removed for evaluation.  Examples include shave biopsy for raised lesions and partial punch biopsy for flat lesions and pigmented lesions.  An excisional biopsy involves the removal of the entire lesion for evaluation, and examples include large punch biopsy, saucerization, and fusiform excision.

Pigmented lesions should have a full-thickness punch biopsy.  This is because, in addition to determining whether the lesion is melanoma, additional features such as the depth of penetration, plays a key role in subsequent work-up and treatment planning.  If the initial biopsy of melanoma was performed as a shave or superficial biopsy, it will distort the assessment of the actual depth of penetration.  While most literature indicates the type of biopsy does not negatively impact the melanoma survival rate, one should perform a full-thickness biopsy which will help with accurate tumor staging, prognosis, and subsequent treatment planning.

Treatments

There are several treatment options for basal cell carcinoma and squamous carcinoma of the skin.  For areas of low risk of recurrence, superficial ablative treatments may be adequate.  These include electrodesiccation and curettage, and cryotherapy.  While these techniques are the simplest and least involved, the downside is that, without the actual removal of the tissue specimen, we cannot have the histologic confirmation of margin clearance.

For most, basal cell carcinoma and squamous carcinoma of the skin, full thickness ablation with histologic confirmation of the margin clearance allows for the highest cure rate.  This type of wide local excision involves en bloc removal of the lesion along with a margin of adjacent clean tissue all around the lesion including the deep surface.  While various guidelines for an ideal margin of clearance exist, most literature supports 3 mm of clear margin for basal cell carcinoma and at least 5mm for squamous cell carcinoma of the skin.

Through coordination with our partnering pathologists, we are able to provide a same-day frozen section evaluation in the office setting to ensure a complete excision of the entire lesion as well as an adequate clear margin surrounding it.

Surgical Dermatology in Syracuse, Rochester, and Ithaca, NY

Repair of the Skin Defect

After the skin lesion or cancer has been removed, there will be a skin defect, or a “hole in the skin”. Depending on the size and the location of the skin defect, there are several options for repair. In the face, head, and neck area, careful planning is particularly important because so much of cosmesis and function depend within these areas.

For a small skin defect, careful and meticulous closure can lead to an excellent cosmetic and functional outcome. Small skin defects in some areas with concaved surfaces such as the inner corner of the eye or the temple often heal nicely without any repair.

Other areas of the face, such as the rim of nose, around the eyelid, or the lip should be approached with a low threshold for surgical repair.  Surgical repair will involve recruiting skin tissues from surrounding areas to fill the defect from the excision. The specialists recommend this method because the closure of the defect is not the only goal of the repair. One must consider subsequent functional problems that may arise in these areas following healing and contracture of the tissue. These problems may not be evident until there have been enough time lapses for wound contracture to occur.

For example, if the skin defect is adjacent to the eyelids, the nose, or the lips, suboptimal repair may still look acceptable immediately following simple closure with stitches.  But months or sometimes years later, as the wound heals, the skin tissue at the repaired site will begin to contract and deform the adjacent structures.  This is the process that can lead to retracted eyelid with dry eye or scarring of the cornea, retraction of the nasal rim or collapsing of nose with compromised nasal airway, or the retraction of the corner of the lips resulting in drooling and slurred speech.  Carefully planned repair procedure at the time of excision (sometimes by recruiting surrounding healthy tissue to cover the defect) will help prevent such complications and also lead to optimal cosmetic outcome in the long run.

Follow-up/Screening

For patients with a history of skin cancer, there is almost a 10-fold increase in incidence of another skin cancer at a different location compared to the general population.  Therefore, routine screening is important for patients who had skin cancer.

For basal cell carcinoma, which is known to be locally destructive but without the tendency for regional or distal spreading, one must monitor the excised area to ensure that the cancer does not return. For cutaneous squamous cell carcinoma, almost a 95% recurrence from the initial cancer will be detected within the first five years.  Therefore, consistently follow-up for the first 5 years after the treatment of squamous cell carcinoma is appropriate with palpation of regional lymph nodes during the annual visits and sometimes with aid of CT imaging.

For the melanoma, depending on the initial staging of the disease, the patient may be closely followed by more than one specialist, especially if it was treated in a multidisciplinary fashion. Most importantly, the patient and his/her family should be actively engaged in routine self-examination.  As described above, if there are any lesions that show suspicious features, one should promptly notify their health care provider.

Double board-certified Facial Plastic Surgeon Dr. Sang W. Kim at Natural Face Clinics specialize in aesthetic enhancement of the face, head, and neck, exclusively. Patients come to see us from the Syracuse metropolitan area and Central New York area including Ithaca, and Rochester. At Natural Face Clinics, we specialize in restoring the youthful neck contour, tired appearance of the brows and eyes, and skin laxity. We offer customized treatment, both surgical and non-surgical, including facelift, eyelid surgery (blepharoplasty), nose surgery (rhinoplasty), brow lift, neck lift, and skin resurfacing. Find out more by scheduling your personal consultation today.

MEET THE DOCTOR

Dr. Sang W. Kim

Harvard Trained, Double Board Certified Facial Plastic Surgeon

Sang W Kim, MD is a double board-certified facial plastic surgeon who specializes in cosmetic and reconstructive facial plastic surgery, nasal/sinus surgery, and hair restoration surgery.

TESTIMONIALS
We invite you to share your experience online at RealSelf.com. Click on the button below to leave a review!  -

I found everyone at Natural Face Clinics to be very friendly and accommodating. During the procedure I became ill and both Dr. Kim and Susan were very compassionate and I did not feel rushed. As of this date, the results are great and I am happy with the end result. Dr. Kim has been very kind and professional. He is a great doctor. The staff is very kind and caring. They are always friendly and accommodating on the phone and in the office. I would definitely recommend Dr. Kim to my family and friends. Thank you for everything!

- Joanne – East Syracuse, NY

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Everything about the procedure was well explained and it was a breeze! The chin surgery came out well and as expected. The doctor was very professional and put me at ease. He explained everything that he was doing. The staff is top notch and Karen was outstanding.

- Carl – East Syracuse, NY

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The initial visit was informative and reassuring. I was given options and a clear understanding as to what to expect. It was very comforting. I received excellent care and I am thrilled with my results! I’ve already booked my next procedure. I was pleasantly surprised with how little pain there was and how quickly I recovered.
Dr. Halliday is wonderful! He is knowledgeable and professional. I wouldn’t trust my face to just anyone. He is an excellent plastic surgeon. The staff is professional, caring and attentive. Appointment times are honored and the visits are never rushed. I am so grateful for the outstanding care I received.

- Susan – East Syracuse, NY

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My experience was very professional and helpful. My questions were answered that I did not think to ask. They were very friendly and accommodating. The procedure went smoothly. Post-op care was especially spoiling, considering it was during the holidays. Everything was done to ensure I had an optimal outcome.
My results are splendid! I am receiving compliments that I look 15-20 years younger than prior to my procedure. My doctor was outstanding and genuinely concerned. He wanted me to understand what was being done and why. I had clear and concise answers to questions and received excellent bedside manner. The staff is friendly, efficient, on time and on task. They are eager to assist! I would recommend and would use again when needing cosmetic enhancements. I am very, very pleased with my experience and results.

- D.L. – East Syracuse, NY

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When I look in the mirror, I know I made a great choice. Dr. Halliday and his exceptional staff were thoughtful, knowledgeable, and caring. My results were very good and not over-done like some actress on TV. I have referred friends and they also had great results.

- Mary - New York Mills, NY

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I cannot begin to tell you how happy I was and continue to be with Dr. Halliday and his staff. I felt very comfortable the first time I met him and talked with his staff. I was treated professionally and with dignity. I originally met Dr. Halliday to discuss fillers. After talking to him and discussing all my options, I decided to have a face lift and surgery on my upper and lower eye lids. He never pushed me into making a decision, in fact, he told me to think about it. I left and headed to work and I called the same day and booked my surgery. He is an artist and a master at what he does. I am extremely happy with my results. I have and will continue to recommend Dr. Halliday and his staff to anyone interested in improving their appearance.

- Debbie - Syracuse, NY

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This whole process has been an amazing experience. The staff and Dr. Halliday treat you with respect and also assure your privacy. The staff is efficient and communicates well; you have complete knowledge of the process and the outcome is absolutely awesome. Thank you!

- Dale - Ilion, NY

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At my initial visit I was met with a short wait time and a friendly staff. Throughout the whole procedure I was comfortable and I healed well and had no problems; I am happy with my results. Dr. Kim is so nice and friendly. He answered all my questions and made me feel safe and comfortable. The office staff has been very friendly and helpful as well. Everyone is so nice here.

- Karen – Syracuse, NY

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When I met Dr. Kim and the staff, everyone was friendly. Dr. Kim did a good job with my procedure and made me feel comfortable. My hair has started to grow and I feel like the procedure has worked. Everyone here is nice and I liked Dr. Kim’s honesty with me. My doctor wanted me to go to a different doctor for my nose but I told him “no I want to go to Dr. Kim”.

- Ljupco – Syracuse, NY

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At my initial visit Dr. Kim and the staff were very informative on what was going to happen with the surgery. He removed Melanoma from the left side of my nose and it very good. All of the Melanoma has been removed and is healing well. Dr. Kim has been very informative on all that has taken place and what is in the future after surgery. The staff has also been very helpful throughout the whole process. I would see Dr. Kim again if I had any more cancer to be removed.

- Eugene – Syracuse, NY

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My initial consultation was very informative. The doctor was honest about the procedure, as well as, the cost and I felt no pressure to make a commitment. The office itself is very comfortable and the staff is friendly and welcoming. My procedure went smooth and the doctor was very cautious to not release me until he was sure I was ready to leave. I am very happy with my results and the healing time was even better than expected. Dr. Kim has an excellent bed side manner and his staff made the whole process enjoyable. He is easy to talk to and very informative about the procedure, as well as, advice on the healing process. I would definitely refer my family and friends to this practice.

- Linda – East Syracuse, NY

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Dr. Kim and the entire staff are nice. Dr. Kim did a good job and everything is 100%.

- Nevzad – East Syracuse, NY

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My husband and I met with Dr. Halliday and Terri. We arrived to a very clean and inviting office and did not have to wait long. Dr. Halliday and Terri did not tell me what should be done but were interested in what my goals were for a cosmetic procedure. They answered all my questions and explained their recommendations clearly. On the day of my procedure everyone went out of their way to make sure I was as comfortable as possible. I liked the “privacy” of the operating and recovery area. I feel like l look years younger while still looking “age appropriate”. Friends and family have commented I look good and the natural lift is exactly that; very natural. The only way people know I had a procedure is because I told them. Dr. Halliday was very professional and friendly the entire time. I completely trusted all the decisions he made during the procedure. He took his time and even took time to put my husband at ease about having the procedure done. Everyone at the office is extremely friendly and I have never had to wait long for my appointment. I feel like I have made an investment in my face and while I am happy to be my age I am even happier to have a face that matches the body I have. I will continue to make enhancements along the way with Dr. Halliday, Terri, and everyone in his office who made me feel and look special.

- Nicki – East Syracuse, NY

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The staff is very pleasant and helpful. I am very pleased with Dr. Hallidays expertise.

- Debra Victor - East Syracuse, NY

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This is a wonderful place to come, everyone is great and happy. I had the best care and will recommend this surgery center to my friends.

- Linda - Syracuse, NY

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I was very worried about my surgery. However, the doctor and staff were wonderful and my surgery and recovery were well worth it.

- Shirley – Syracuse, NY

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