hey welcome for joining us I’m here with my friend John he’s been a patient for 10 years probably and we’re going to do a cyst on his back it has been there for years years and what happens with it was fills up with a way to gooey substance that does not spell appealing and it’s time to get it removed ok then you had stuff come out of it lately right oh yes yeah okay so we’re going to get this taken out it’s probably epidermoid sister feels like one and by outlining the margin where you can feel the raised part of it we can get an idea of how large it is at least how large the skin around it is and take it out probably with an elliptical excision that would work best many of our viewers have probably seen dr. pimple popper do simple similar procedure oftentimes she’s a punch biopsy first and then the sect around the system we’re just going to go in with analytical excision on this case first and Jack where it’s going to be feel that John sorry you’re always so easy going you do feel it all right oh yeah okay one of the things I’m not thrilled about with this going into it is that it’s had a lot of trauma to it with the squeezing and the healing and the squeezing and the healing and so that it’s going to be kind of tough with some scar like tissue might make a hard to get a nice neat removal of a sack on one piece the sack may actually be ruptured at the moment when I was feeling it before we got started i was able to feel the edge of it you can’t do that once the anesthetic has filled all of the superficial tissue it’s all hard and for so you just kind of have to go by your your landmarks which is the the drawing with a pen I’m going to make a vertically oriented ellipse and then we’re going to going to the sect assist out once we do this that’s one side of the lips this is the other side of the lips so now I’m going to sort of trace what we just did but what’s nice is the blade likes to go in we’re already cut so it’s not like a totally blind and I can kind of feel that a minute and the reason I’m not just aggressively going to hit and going in is because there’s there’s a cyst that will rupture inside of there and I don’t want to rupture if I can help it you’ll see different techniques watching the different channels and you’re just watching one channel you’ll see different techniques one of the things that you’re noticing is how thick the skin of John’s back is not terribly unusual for a back to have skin it’s really thick it’s not the john cystic skin so please do comments they add comments if you have comments about to John’s experience here for similar experiences you’ve had my let’s look down here and i’ll see that right there think I want to set around that we’re just finishing getting through the skin here you can see how that’s I don’t know if you see yellowish fat it’s actually about the same color as the skin but then we come around this side we have this white structure below the skin right there kind of roundish looking i don’t want to use a sharp knife right on that I want to use well scissors are short two but scissors if you go in and separate like that can do what we call blunt this section separate as dr. tan used to say just freed up around it but being careful not to rupture the cyst because i think it’s there’s lots of videos of them where the doctor ruptures assistance squeeze it all out because there’s a lot of people who love seeing that stuff come out that you know after all it’s dr. pimple popper there’s something satisfying about seeing all that come out i think there’s something satisfying about taking it out on one piece i forgot don’t find ok they’re they’re both interesting being also careful and if you happen to be a physician who does this procedure please comment we would love to hear words of wisdom you have to share with us okay look at that totally entertaining other people we will get comments that they don’t come off now saying oh please why didn’t you when you open it why don’t you get all the contents out like that because i want to give it to the pathologist just like that I want them to have the whole thing to look at that that is beautiful now the reason I’m not put a suture in the twelve o’clock location on this one is because we’re not concerned about a cancer and whether it’s still left behind we’re just we’re just sending them off assists 2-centimeter maybe 1.1 take a big bite of the deep part they’re starting from lower and coming out higher and then going to the opposite side and starting higher and coming out lower see what i’m doing here ok so what I’m doing is making it so the knot is going to be the bottom and this pulls the deeper tissues together to take some of the tension off of the skin there we go good all right there it’s holding now job and then you cut it just above the knot the more comfortable never change do out to make you telling the CL Moore together oh you’re a genius John it worked don’t move you’ll notice because of how tough the Skip wasn’t actually bent the needle it normally is a different curve that’s a more currencies straightened it out straightening the curves what’s what’s what’s the song would help my tony was from its television program would it help if I told you what the visual wasn’t went with that line of the song if I get the character in way it gives away or the name of style of shorts is that from you that happened it was Hank Williams jr. wasn’t it it’s not you’re going to hear about it no comment below look at this let’s get dr. look at this all that trouble to come up with a beautiful vertical linear scar there’s a song about that too jim morrison’s grave by Steve Taylor ok five and my sense of aesthetics is killing me to not have one located here is that bothering anybody else have one there yes but it’s not necessary for it to heat it’s just so we will have input beautiful dressing on that just beautiful totally intact the pathologist will take it a person and tell us what it is John did you see it no oh you guys see it that’s what that has been squirting out yet yeah there’s a lot of tension there still we do want you to not be doing things really pulling with your arms that will pull on this a lot over the next 10 days while we’re leaving the sutures in and now that you’re on this side of it you’ve experienced it with what words do you have for people who might be going under a similar procedure not a problem a lot larger than i expected haha sometimes they are yeah but we got it up we have John came back because he thinks he may have broken a stitch from the procedure that we did let’s check and see it looks good from the outside did you feel something or was a pain well where did he change the bandages for is you know where there were six stitches is only through the holes are but the stitch wasn’t in the band it’s our nature didn’t suck inside you feel it mmm i pulling that’s the the vertical mattress the knot is to the side so it’s intact oh it’s just where where the incident is that’s where the suture goes under and across the back out close this up and then I’ll draw a little diagram showing exactly if this is the wound the skin above it the way that suture works is we go in and we take a bite and we come out and then instead of tying across here go back in take a bigger bite and then type over here on the side so that not is off to the side and it allows us to get a lot more surface area that the sutures pulling on because we had all that tension so actually you know your concern but I’m really happy without life excellent yeah so you’re not heard no okay so this is the day after we did it right correct post-op day 12 and well hey thanks for watching guys even got to see a little bit of follow up there with the day after so John’s doing great and if you haven’t already subscribed please do subscribe to the channel so you don’t miss future videos and if you want to watch some more you can see a little video that you can go to now to watch more procedures of the offer medical group stay good help