Frank Bures: Personal opinions of protruding facial growths

August 19, 2018

Dr. Frank Bures

I had the opportunity recently to relearn a lesson that I’ve been taught by several people over the years, from a 16-year-old patient — proving you’re never too old to learn or too young to teach. The lesson is that protruding growths or appurtenances (love that word) on a person’s face can create very strong private feelings about them, like the desire to have them off or changed (the growths, not the faces).

This very nice young man had a rather largish mole that was sticking out a bit, growing next to his nose. It had been there since he could remember, meaning it was by definition congenital. It measured about a quarter inch in width and perhaps the same in elevation. He wasn’t unduly distraught over it. He just didn’t care for it. His mom was there, and said OK if he wanted it removed, aka chopped off. There wasn’t any concern about malignancy by either of them. He was quietly but privately quite self conscious about it. He said it seemed to really stick out when he looked into the mirror. I said, “Don’t look in the mirror” — yeah, right!

I explained the couple ways of detaching it, both using an anesthetic. We’re quite modern. He opted for a shave excision instead of sutures. Job done, he tolerated the procedure very well, and was breathing at the end. Another patient survived.

I called his home a few weeks later to ask how the healing was going. Mom said it looked great, and was really becoming less noticeable. I asked her how the patient felt about it. She said he was just happy that it was gone. The easy translation of that, which I’ve heard many times before, is that the place was flat, and no longer stuck out WHEN LOOKING IN THE MIRROR.

Mirrors can be evil inventions, especially when I peer into them now, and see this old person gazing back at me. The growths that hang down under chins, almost to belly buttons, or jut out from in front of ears are particularly visual focal points for the owners. Flattening the doodads so they can’t be seen in profile most often is completely satisfactory. What minimal scar there may be left is very inconsequential for most patients in my experience.

Part of the lesson is that we all have private, often strong feelings about personal parts of us, be it a growth, the shape of your nose, hair in all manners of ways, body size or shape, and so on. I’ve learned that it is s person’s privilege to have those feelings, regardless of what others see or say. And they can’t be changed very easily by someone just saying it’s okay. As long as it’s not an obsession to the point of becoming a real diagnosis of body dysmorphic syndrome (a situation where the person sees a distortion, which is not there) it usually can be dealt with in some fashion.

The doctor’s task is to assess the individual’s degree of distress from their perception, and the possible realities of improving the person’s feelings toward the mole, nose, or whatever, without creating a bigger medical or financial problem. In our patient’s case it was pretty straightforward. In more involved situations more factors have to be considered to decide if the outcome will be better. You can lop off a mole, but noses, well, just flattening them isn’t always the best choice.

Our young guy doesn’t feel the bump is sticking out past his nose and hitting the mirror anymore. Would that everything could be that easy. If you have strong sentiments about a personal feature, it is your privilege to pursue realistic possibilities of improving it in your own opinion, not others’ opinions. There is nothing wrong with doing it if it’s financially and practically feasible. Enhancing your self-image is valuable in more than just one aspect. I’ve seen it many times over. Now, if you want to turn yourself into something you’re not, or become 4 inches taller, we need to talk.

Always remember, a smile is a facelift you get for free.

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