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Syringoma Treatment

Syringoma Treatment Los Angeles

 

There are many different reasons why the skin on the lower eyelid may begin to age.  One of the most common problems associated with the lower eyelid is a condition known as a syringoma.  A syringoma is a benign tumor of sweat gland origin that occurs as tiny white bumps on the lower eyelids, cheeks, and upper eyelids.  Historically, syringomas are associated with women more than men, and are thougth to occur as an overproduction of sweat gland tumors on the eyelid skin. 


Raffy Karamanoukian Hollywood Plastic Surgeon

 

Syringomas are often associated with certain ethnicity, including Asian ancestry or mixed ancestry involving African, Asian, Polynesian, or Caucasian heritage.  Syringomas are unlikely to involute over time and tend to grow progressively and often multiply over areas.  On the lower eyelid or face, progression of syringoma occurs with a gradual coalescing of multiple syringomas into larger lesions.  There are many reasons why syringomas occur, but the most likely origin is probably related to genetics.

 

Syringomas are seen clinically as small raised bumps on the upper or lower eyelids and less commonly on the cheeks and temples .  They are nonpigmented bumps on the skin and are often red or inflamed, occurring in combination with oily skin and acne.  Syringomas are not cancerous and are usually defined as benign growths on the face.  When examining syringomas, they often appear as tiny bumps on the skin or as white lesions that are spread out over the eyelid skin.  They are defined as a proliferative skin problem that is derived from the sweat glands of the skin.

 

The majority of people who seek treatment for syringomas do not know what the diagnosis is, but are often confused between parallel problems including sebaceous gland hyperplasia, milia, active acne, normal oil glands, or syringomas.  Syringomas are characteristically bumpy and often appear whitish in appearance. 

 

The first step in treating syringomas is to properly diagnose the problem and to assess the likelihood of skin pigmentation with treatment that often depends on native skin color.  Syringomas do not usually resolve if left alone and there are new permanent options for removal and improvement of syringoma-ridden of skin. 

 

The most common types of syringoma treatment include chemical peels, electrodesiccation, laser ablation, hyfrecation, and selective burning of the syringomas.  The majority of these treatments act to flatten and destroy the active syringoma nodule. 

 

The office of Dr. Raffy Karamanoukian specializes in the treatment of cosmetic facial problems and our expert clinicians have expertise in the management of syringomas.  Syringomas are typically found across all skin types, but are likely more common in Asians, Polynesians, Pacific Islanders, African, and African‑American.  The treatment choices in syringoma management vary depending on the type of skin and the likelihood for scarring and pigmentation. 

 

Dr. Karamanoukian will discuss your options for treatment on your skin type and will recommend a pre and postprocedural topical cream program with Melaquin AM and Melaquin PM in order to decrease the risk of postprocedural hyperpigmentation or hypopigmentation.  Syringoma treatment often requires more than one session and patients are typically extremely pleased with the overall treatment effectiveness and low recurrence rates.

 

If you chose to undergo treatment for syringomas it is often prudent to seek early treatment as delaying treatments of syringomas often lead to progression of the problem and a deeper penetration of the syringoma tumor.

 

Patients who have syringomas often fail to notice the progression of the problem and often seek consultation with Dr. Karamanoukian at a later point in the disease process at which time there are multiple syringomas that have coalesced or combined together.  In addition, early treatment requires less invasive management as opposed to longstanding syringomas which may require deeper penetration of the hyfrecation or electrodesiccation. 

 

The main types of syringoma treatments include hyfrecation and electrodesiccation, chemical peels, fractional CO2 laser, and selective pulsed CO2 laser. 

 

Dr. Karamanoukian is a board certified plastic surgeon and an expert in the management of facial cosmetic surgery, problems and syringomas.  He is acutely familiar with the management of syringomas in the patients with lighter complexion or deeper darker complexions.  Specific treatments for syringomas are obtained after a thorough consultation and examination of the syringomas and surrounding skin.  The goal of syringoma treatment is to minimize surgical problems and surgical complications.  Dr. Karamanoukian will first advise you to begin a topical cream program with Melaquin AM and PM in order to minimize the risk of post-syringoma treatment hyperpigmentation or discoloration.


On another note, some patients will confuse a syringoma for a xanthelesma or milia.  Each of these occur near the eyelids, but represent distinctly different problems of the skin.  Syringomas are benign tumors of sweat gland origin and can be found around the eyes, on the eyelids, eyebrows, forehead, and cheek areas.  As a skin problem, syringomas are relatively easy to treat and require pre and post treatment consultation and preparation. Xanthelasma are small plaques of cholesterol deposits that are found underneath the thin skin of the eyelids.  Although they are usually composed of cholesterol deposits, they are not intimately related to the cholesterol level in your body.  It is thought that xanthelasma are genetically linked and thus not related to diet or cholesterol levels.  Treatment includes surgical excision and ablation.  Recurrence of xanthelasma is known to occur.  

 

CRYOTHERAPY OF SYRINGOMAS:

Some studies have shown the efficacy of cryotherapy, or freezing of syringomas.  Cryotherapy is effective but has a higher risk profile as it is nonselective in terms of syringoma treatment versus surrounding normal tissue.  Dr. Karamanoukian advises against cryotherapy as there is a higher risk of hypopigmentation and whitening of scars and normal skin.  Cryotherapy has been used successfully in isolated syringoma cases, but it is more difficult to use along the eyelid and eyelash margin.

 

HYFRECATION AND ELECTRODESSICATION OF SYRINGOMAS:

 

Electrodesiccation of syringomas is also known as hyfrecation.  In this very meticulous technique, a small hyfrecation needle is used to selectively destroy and thermally injure syringomas on the surface of the skin.  Hyfrecation treatment is among the goal standards for syringoma treatment and can be used effectively to reduce the syringomas without increasing the risk of hyperpigmentation or hypopigmentation scarring. Dr. Karamanoukian feels that hyfrecation is the treatment of choice for the majority of syringomas, particularly those that appear on Asian skin, Pacific Island skin, and African-American skin.

 

SURGICAL EXCISION OF SYRINGOMAS:

 

Some syringomas on the lower eyelids are amenable to surgical excision and cutting.  In this particular treatment type, Dr. Karamanoukian will mark out the area of syringoma growth and combine the excision with an eyelid procedure in order to remove the syringoma affected areas and suture repair of the skin.  Surgical excision is reserved for areas of scar tissue and areas of recurrent syringomas that are resistant to normal treatment.  During your consultation, Dr. Karamanoukian will advise you of your risks for syringoma excision and repair.

 

FRACTIONAL CO2 LASER FOR SYRINGOMAS:

 

The fractional CO2 laser is also effective in the treatment of syringomas.


Dr. Karamanoukian utilizes the fractional CO2 laser in combination with hyfrecation or electrodesiccation in order to destroy the skin and effectively retexturize the skin postoperatively.  Fractional CO2 laser, although effective as a combination therapy for syringomas, it is less effective when used alone on the eyelid skin.

The depth of penetration of fractional CO2 laser makes it effective for the eyelid skin.  If you have questions about fractional CO2 laser and UltraPulse CO2 laser for syringomas, please call our Los Angeles plastic surgery office and speak to one of our patient care coordinators regarding these innovative strategies for syringoma treatment.  Dr. Karamanoukian will not recommend fractional CO2 alone as ineffective single modality for the treatment of syringomas.

 

Recovery after syringoma treatment varies widely depending on the depth of the syringomas as well as the depth of treatment.  Unlike other procedures, hyfrecation and electrodesiccation will selectively destroy syringomas and you will be left with the small scab on the skin at each of the areas of treatment.  These scabs will usually last for three to five days, leaving a more flattened appearance to the syringoma affected skin.  At the one month interval, Dr. Karamanoukian will recommend a fractional CO2 laser in order resurface and retexturize the skin and reduce the chance of syringoma recurrence.  If you have questions about syringomas or syringoma treatment, when combined with milia, or sebaceous gland hyperplasia treatment, please call our Los Angeles plastic surgery office at 310-998-5533.


CLINICAL RESEARCH ON SYRINGOMAS:


Dr. Raffy Karamanoukian is one of the premier experts in the treatment of syringomas of the face and eyelids.  He has refined his techinique for syringoma removal and treatment by using a combination of hyfrecation and fractional CO2 laser.  Treatment of syringomas has evolved over the last few decades and is now based on the concept of electrodessication for elimination of the syringoma and fractional ablative laser for resurfacing of the skin on the eyelids and face.  There continues to be exciting new treatments and research in the field of syringoma management and the following illustrates some of the current thinking in syringoma therapy.  


  1. Nerad and Anderson published an early report in the Opthalmologic Plastic & Reconstructive Surgery journal regarding the treatment of syringomas with CO2 laser.  In this study, ablative CO2 laser was used, whereas newer technology clearly defines fractional CO2 as the leading resurfacing modality for these patients.   Fractional CO2 reduces risk of scarring and can be performed safely in an outpatient clinical setting with minimal anesthesia.  
  2. Suprapulsed CO2 laser was also used in the surgical management of facial syringomas by a team of researchers at the UCLA School of Medicine.  The study was published in the Journal of Clinical Laser Med Surg and written by Castro et. al.  Using a suprapulsed CO2 laser, the individual syringomas of the lower eyelid were ablated without incident.  There was no evidence of scarring, ectropion, or pigmentary changes in the patient group.  The complications noted were mild erythema or redness, with complete healing in the study period. 
  3. As early as 1990, the cosmetic applications of the CO2 laser were discussed in depth.  Toregard wrote on the utility of CO2 laser in the management of many cosmetic surgery procedures, including blepharoplasties and aging skin treatments.  Laser applications in syringoma treatment remain a mainstay of therapy and can retexturize the skin and even out surface imperfections.  Syringomas represent a large problem for many ethnicities, including Asian, African American, Caucasian, and Latino cultures.  The treatment of syringomas among Asians is widely requested and can be performed with maximal safety and efficacy. 
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