First of all a Happy New Year to all my readers and subscribers! This is my first Newsletter for 2025 and it is very special. Lots of stuff in this one.
I'm Dr. Red Alinsod, and I want to talk to you about something that might be bothering you - external anal skin tags. Now, these are not something to be too worried about, but I know they can be a nuisance or even a little embarrassing. Few doctors take care of these problems. GYNs, General Surgeons, Colorectal Surgeons, Gastroenterologists mostly run away from these surgeries because they are typically not covered by insurance. I decided to make this a major focus of my practice about 20 years ago. In Dallas where I practice, I have pursued the woman who wants to get rid of anal skin tags. Patients from just about every state fly into Love Field or DFW Airport, drive a few miles, get these removed and they fly home in the afternoon or evening!
Today’s Newsletter will focus on clinical outcomes and what you can expect from surgery to remove those Anal Skin Tags, aka “AST,” using Radiofrequency surgery (RF). I have taught hundreds of doctors this technique around the world. I was the first to present this surgery in any Cosmetic Gynecology/Gynecology/Plastic Surgery Congress. More anal skin tag surgeons have this less expensive radiofrequency technology (made by Ellman or Soniquence in the USA) and this is what I used to teach my Fellows in the past 18 years. In my personal practice I have transitioned mostly to the CO2 Laser made by LightScalpel. It is a very expensive laser so few practices own one. I developed the protocols for LightScalpel for its use for gynecologic and AST surgeries. Women seek us out because of this laser and the comfort and rapid healing and beauty it can provide. Both Laser and RF technologies work well and now, between the two newsletters, you get both sides of the story.
We are the best and busiest Anal Skin Tag center in Texas and want to brag a bit of what we have to offer our patients. This is an update on my newsletter published on February 1, 2024: Those Pesky Anal Skin Tags. I focused on using the LightScalpel Laser on that video shown below:
Let me do a quick summary first:
What Are ASTs?
External anal skin tags are just little bits of extra skin that hang around the outside of your anus. They're benign, meaning they're not harmful or cancerous. They look like small flaps or bumps, and they're usually the same color as your skin or a bit darker. They're pretty common, especially if you've had hemorrhoids or anal fissures in the past. When those heal, sometimes they leave behind these little skin tags.
How Do They Occur
These tags can pop up for a few reasons. Often, it's because of the stretching and irritation from conditions like hemorrhoids or fissures. After the swelling goes down, the skin doesn't always shrink back to how it was, leaving these tags behind. Pregnancy, obesity, or even just the natural aging process where the skin loses elasticity can contribute to them. Low fiber diets and lots of red meat eating can make things worse. Sometimes, it's just genetics playing a part.
Treatment Options
Now, if these tags are bothering you - either because they're itchy, uncomfortable, or you're just not happy with how they look - there are ways to deal with them:
- **Watchful Waiting:** If they're not causing trouble, you might decide to leave them be. They're harmless unless they get irritated. If the appearance does not bother you just leave them alone.
- **Home Remedies:** Some people use over-the-counter remedies to minimize symptoms like itching (Preparation H, Anusol, Hydrocortisone). They can give relief and shrink them down a little bit. I always caution against trying to remove them at home yourself. It's not safe and can lead to bleeding, infections, or worse.
- **Professional Removal:** This is where I come in. At the Alinsod Institute, we offer specialized treatments for skin tag removal. We do not use rubber bands. We use techniques like:
* Laser Surgery: The least invasive option where we use a CO2 laser to excise and vaporize the tags. This technique is hard to find because of the expensive laser. Make sure the practice has a LightScalpel laser because not all lasers are as effective. This method is the best for its precision and minimal discomfort when done by an experienced surgeon with the right tools. Rare scar formation.
* Radiofrequency/Electrocautery: Using radiofrequency energy to shrink and remove the tags. This method helps control bleeding and speeds up healing. Usually no suturing is needed so much less chance of scars. An excellent method I use. I use the Soniquence system. They have the best Bipolar system
* Excision with knife: Cutting them off with a clamp and a knife under local anesthesia. It's quick, and you can go home the same day. More scars because of frequent need of suturing. More pain due to the sutures used. I do not use this method.
Summary of Risks/Benefits/Options
* Risks: pain, bleeding, infection, scars, recurrence, need for repair or redo, they do nothing for the internal hemorrhoids. You can have reactions to medications given for pain and comfort such as an allergic response.
* Benefits: comfort, stop the bleeding, cleanliness, beauty, confidence.
* Options: leave them alone, topical creams to shrink them or reduce inflamation, rubber banding, consult with another surgeon, surgery with laser or radio waves or knife.
Preparation
There's not much you need to do before coming in. Evacuate your bowels, keep the area clean, but you don't need to do any hair removal or special prep. You do not want to do this surgery if your hemorrhoids are acting up, bleeding, and engorged. Anal skin tag Surgery is for when the hemorrhoids have calmed down, not inflamed or bleeding, and are only external and outside the anus.
Procedure Details
We'll do this in our procedure suite. Not the hospital or Surgery Center in most cases. It's a quick, in-office procedure under local anesthesia. I do them in the Surgery Center upon request such as severe anxiety or a serious medical condition. We have a magical device called “electroporation” that opens up your skin’s water channels and pushes concentrated “BT” (Bupivacaine/Tetracaine) numbing cream deep to make it numb so you do not feel the needles. Go to this April 1, 2024 newsletter calls “Needle Free Non-Injections” for all the details of the technology. It is very cool! I developed the protocols for gynecologic use over a decade ago. After electroporation you then get the local anesthesia injection that has bicarbonate in it so there is less burning sensation. I will use the LightScalpel or Soniquence RF for precision surgery, which minimizes pain and speeds up healing. If needed I will use Monsol Solution to take care of any minor bleeding areas. It replaces suturing. It takes about 30 to 60 minutes of total time, depending on how many tags we're dealing with. The actual surgery is probably only 10-15 minutes. The two videos I provide in this newsletters gives you lot of details about my technique.
Pain Management
The best way to manage the post op discomfort is to use the 30% numbing cream we will provide. It is wonderful “BT Cream” mentioned above. You can use it on a regular basis when you feel uncomfortable. You will not get toxic doses. That and the use of ice packs will provide pain control and reduce the puffiness. Pain management is crucial, and you'll get prescriptions for that. Typically it is Ibuprofen and a mild narcotic such as Dilaudid or Tylenol #3 for the times when the cream alone is not enough. Lastly, if you want to get about 3 days of numbness (let’s say you are traveling to Dallas then home by plane or long car ride) then consider the use of Exparel. It is a local injection I can give you at the end of the case that provides long term numbness (3-5 Days on average). It is made of Bupivacaine local anesthesia surrounded by a liposome/fat coat for slow steady release.
Recovery
Post-surgery, you'll likely be advised to take it easy. You can drive immediately after surgery and do all the normal life stuff if you did not receive any oral or injected medications (e.g. Ativan, Valium, Demerol, Dilaudid, Zofran). You must be on a high fiber diet with fiber supplements for a month to avoid straining during bowel movements, which can be uncomfortable with fresh surgical sites. Veges, fruits, nuts, legumes, roots, prunes, prune juice. I insist on Milk of Magnesia daily to keep the stools the consistency of toothpaste. OTC Fibercon, Metamucil, Colace are also quite helpful. You do anything and everything to keep that stool soft but not watery. Do not just go on a liquid diet. It is not healthy in the long run.
Post-Care
You can go to the gym and exercise to your heart’s content if you can tolerate the discomfort during healing. I recommend using the numbing cream before exercise and not to use the bike or anything that pushes on your vaginal and anal areas. You can resume sex at 6-8 weeks once fully healed. You may spot and have light bleeding so wear a panty liner.
We don't just leave you after the procedure; we're there for follow-ups, to answer questions, or deal with any concerns. We want you to feel confident and back to normal as swiftly as possible. We will call you regularly and make sure you are doing well. You will have my personal Private Patient number. You will have Dian’s number. We answer at all hours of the day or night. We answer texts and emails immediately. We can Zoom or FaceTime too.
Why Choose Me?
In Texas, particularly for women, I've dedicated a significant part of my practice to these cosmetic and functional issues because I understand how much they can impact your life. We look at the whole picture. If you come in for skin tag removal, we'll discuss all your options, ensuring you're informed and comfortable with the plan. I use advanced techniques, ensuring the procedure is as comfortable as possible, and we focus on a recovery that's quick and with minimal discomfort. At the Alinsod Institute, we focus on treatments that are not just effective but also considerate of your comfort and privacy. We ensure you're informed, comfortable, and that your recovery is as smooth as possible. My team and I have seen countless cases, making us experts in both the medical and cosmetic aspects of dealing with these issues.
If you're dealing with anal skin tags and looking for a solution, come see me. My team will get you feeling like yourself again - without the hassle or the worry. Check out more about our approach at alinsodinstitute.com/anal-skin-tag-removal. Remember, you don't have to live with discomfort or dissatisfaction. Let's tackle this together.
Expertise
With decades of experience, I've seen and treated all sorts of cases, ensuring that your procedure is performed with the highest level of skill and care. I have taught this stuff for almost 20 years and have successful grads all around the US and beyond. Go HERE to view my CREDENTIALS.
How much does it cost?
It is actually quite reasonably priced at $2,500. That covers the consult and anesthesia too! You can use your insurance to pay for your pain meds. Exparel is optional and extra.
How do I get in?
Call the office, set up a phone/FaceTime/Zoom or live appointment. Send in your photos securely if it is a virtual appointment. Fill out the forms my staff send you and I will review them and see if you are good to go for an in-office procedure. If you have high anxiety or medical issues needing a higher level of care we will do your procedure in the Surgery Center. You have to pay for the surgery center costs. Your follow up with me will be in 6-8 weeks after surgery either live and in person or virtual and online.
Forms I use
This is the Form to fill out before speaking with me. Pretty simple. Remember to take photos to send securely to us. Dian, my Medical Assistant, will help you and you can call her at 945-900-7576. The other two forms below are the Consent and Post Op Instructions for you to review.
1a H&p Aesthetic Short Form Update 2023
I hope this has given you a good idea of what we offer in Dallas. Go HERE for more Anal Skin Tag cases to view on my website. Scroll below for description of my Case Studies.
Red Alinsod, MD ([email protected], www.alinsodinstitute.com)
CASE STUDIES
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DALLAS OFFICEAlinsod Institute DallasWomen’s Wellness Institute of DallasPreston Sherry Plaza8201 Preston Road Suite 520Dallas TX 75225Phone: 945-900-7576 (Dian White, Medical Assistant)EMail Dian White: [email protected]
Main Website: www.alinsodinstitute.com
I am happy to take care of you in Dallas!
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