The Story of 3 Pilar Cysts: Part 1 of 2

This woman came in accompanied by her physician husband, who has a practice in Southern California as well. She was recommended to see me by her son, who is in medical school and happened upon my videos on youtube. She has three pilar cysts, with two pretty large ones. She was SO kind to allow me to film the removal, and they were fun cysts to remove! I like excising pilar cysts, because the walls of these cysts are usually thicker and more durable so these cysts are more likely to pop out whole. This is ideal, because it usually ensures that we have removed the cyst in its entirety and that it will not likely reoccur.

In this video, I point out a distinctive sound that can be heard when doing surgery on the skin of the scalp. Under the skin and fat, just before you get to the bone of the skull, there is a thin area of tissue called the galea aponeurosis. When you tease and undermine away in this surgical plane, the tissue makes a distinctive noise.. see if you can hear it. Thought you may find this interesting. Also, this is the ideal surgical plane for closure. Although the scalp is very vascular and often bleeds, blood vessels don’t course through this surgical plane, so there is very low risk of bleeding when I am undermining the skin at this level.

Thank you so much for watching!!

A Pilar Cyst, aka a trichilemmal cyst, an isthmus-catagen cyst, or a “wen”, it looks identical on examination to the more common epidermoid cyst, except that 90% of them occur on the scalp. They tend to be more mobile and firmer than epidermoid cysts, and are derived from a different part of the hair follicle/skin. The internal content tend to be more “homogenous”/ smooth (looks different under the microscope), but it is also a benign growth. It is not uncommon to have multiple pilar cysts on the scalp and to have other family members to have these cysts (tend to run in families). Treatment is for cosmetic reasons usually (people don’t like the appearance of them), and excision with removal of the cyst and it’s contents is curative.

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This video may contain dermatologic surgical and/or procedural content. The content seen in this video is provided only for medical education purposes and is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

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