Surgery for Birthmarks in Children

Dermatologists may determine that a birthmark should be removed for medical reasons, or parents may elect to have a child’s birthmark removed for cosmetic reasons. Plastic surgeons at Hassenfeld Children’s Hospital at NYU Langone use special reconstructive techniques to minimize scarring and ensure an aesthetically pleasing, natural-looking result.

Reasons for Birthmark Removal Surgery

Many birthmarks do not require surgical intervention and either shrink and fade on their own or respond well to medication or laser therapy. However, our dermatologists may recommend surgery for some types of birthmarks.

These include certain deep hemangiomas that may damage surrounding healthy skin and other soft tissues, leaving behind wrinkled, papery skin after the hemangioma has shrunk. Some sebaceous nevi, a type of birthmark that usually appears on the scalp, are removed to avoid the progression of a large bald spot on a child’s head. Moles present at birth, especially large ones, may also be surgically removed.

Often, the location of a birthmark is a significant factor in the decision to remove it. Hemangiomas on the face may pose a risk of damage to the eyes, nose, and mouth. Additionally, young children have increased elasticity in their skin that helps speed healing and minimizes the chance of scarring, so our dermatologists often recommend removing a birthmark before a child reaches maturity.

Our dermatologists and plastic surgeons recognize that visible birthmarks can affect a child’s self-confidence. They work closely with parents to ensure that every decision to remove a birthmark prioritizes the child’s long-term medical and emotional health.

What to Expect During Surgery

Most of the time, surgery to remove a birthmark is an outpatient procedure, which means that doctors use local anesthesia and your child can return home on the same day as surgery. 

Our surgeons remove small birthmarks in the doctor’s office in less than an hour. Surgeons inject the anesthesia into the surrounding skin to eliminate pain and then use a small scalpel to remove the birthmark.

The small incision is closed with stitches that dissolve on their own within one week. Many children who have a birthmark removed in the morning return home that afternoon and can go back to their normal activities.

For larger birthmarks or those that are located deeper in the skin, such as deep hemangiomas, our surgeons may use a combination of techniques to minimize scarring and prevent disfigurement.

For example, if a large mole is present on a child’s cheek, our surgeons may elect to remove it in stages rather than all at once. During the first procedure, surgeons remove a section from the middle of the birthmark. They then wait several weeks for the incision to heal. This may be repeated two or three times before surgeons remove the final section of the birthmark, which is now much smaller in size. This reduces the size of the incision that is required for final removal, shrinking the length of the scar.

Another technique that our surgeons may use when removing a large birthmark is called tissue expansion. In this procedure, surgeons implant a small balloon beneath healthy skin next to the birthmark. In the weeks before surgery to remove the birthmark, this balloon is slowly expanded, and new healthy skin cells grow over the balloon to create an extra flap of skin. During surgery to remove the birthmark, surgeons use this new flap of skin to cover the area where the birthmark used to be. The new skin heals with minimal scarring.

If our surgeons remove a sebaceous nevus from the scalp, surgeons may use a similar tissue expansion technique to ensure the presence of healthy hair follicles at this site. Often, a sebaceous nevus is harmless and less noticeable than a birthmark on the face, and doctors may recommend putting off surgical removal until the child is a bit older. However, if a sebaceous nevus is very large, our surgeons may remove it earlier.

What to Expect After Surgery

Most children recover quickly from surgery, but the exact timeline varies depending on the child’s age, the procedure performed, and the size of the birthmark that was removed.

Recovery from the removal of a small birthmark consists of covering the small incision with a bandage and allowing the skin to heal. Our surgeons use special stitches that dissolve on their own after three or four days. This helps minimize scarring. Doctors schedule a follow-up appointment for 7 to 10 days after surgery to make sure the skin is healing normally.

After the removal of larger birthmarks, the area may be sore and swollen for several days. Bandages remain on until the first follow-up appointment, which is scheduled for 7 to 10 days after surgery. Even when a large birthmark requires tissue expansion and transplantation, skin heals quickly. Most children recover fully within four to six weeks.

After any type of surgery, the incision area should be closely monitored. If the surrounding skin becomes increasingly red or swollen, or if your child develops a fever or complains of chills or body aches, he or she should visit the doctor for an evaluation immediately.