Mr. Onur Gilleard
Qualifications & Experience
Mr Onur Gilleard is a distinguished consultant plastic surgeon on the GMC specialist register. He previously held an NHS consultant post at St Bartholomew’s Hospital in London, specialising in skin cancer and microsurgical reconstruction. In 2021, Mr Gilleard transitioned from the NHS to dedicate himself fully to private practice, allowing him to focus exclusively on providing personalised, high-quality care to his patients. He is recognised as an expert in laser treatments, having conducted research and developed advanced treatment protocols using cutting-edge laser technology to optimise both clinical outcomes and cosmetic results.
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On the face, method selection is governed by one consideration that does not apply elsewhere: whatever is left behind will be looked at. All four techniques — fine hyfrecation, scissor snip, surgical excision and cryotherapy — remove a facial skin tag effectively. They differ in how precisely the depth and margin can be controlled, and therefore in how predictable the final appearance is. The usual first choice here for a facial tag is a fine hyfrecator tip or a scissor snip, worked slowly. Excision is reserved for larger or broad-based lesions and for anything requiring a diagnosis. Cryotherapy is available and appropriate for some patients, with a pigment trade-off that carries more weight on the face than on the body.
What the Face Changes
Three things differ from a tag on the neck or under the arm, and together they explain every method decision that follows.
- The result is permanently visible. A flat pale mark on the underarm is a non-event; the same mark beside the nose is not. The margin for an imperfect outcome is narrower.
- Facial skin is thin and structurally busy. The lid margin, the lash line, the vermilion border of the lip and the alar rim are all close together, and all are unforgiving of treatment that spreads beyond its intended edge.
- Pigment change shows. Facial skin is exposed daily, so both hypopigmentation and post-inflammatory darkening are more noticeable and harder to conceal than they would be elsewhere.
None of this makes facial tag removal difficult. It makes precision, rather than speed, the governing priority — which is a different way of choosing a method than simply asking which is quickest.
The Four Methods on Facial Skin
- Fine hyfrecation (electrosurgery) — usual first choice
- A fine electrical tip applied at the base of the tag, removing and sealing in one step. On the face it is used slowly and at low power, which gives close control of depth. Minimal bleeding, no suture, and a small scab that separates over one to two weeks. How the technique works in general is set out in electrosurgery for skin tags.
- Scissor snip — equally suitable for a narrow stalk
- Fine scissors take the tag off at the stalk under local anaesthetic. For a genuinely narrow-based facial tag this frequently leaves no visible mark at all. Seconds per lesion, no suture.
- Surgical excision — for larger, broad-based, or uncertain lesions
- The lesion is removed at the base with a defined margin and the wound closed, leaving a fine line rather than a flat mark. This is the method of choice where the base is wide enough that a superficial technique would leave tissue behind, and it is the only option that preserves the lesion intact for histological examination. Compared in detail in shave vs excision.
- Cryotherapy — available, with the trade-off weighted differently here
- Freezing is offered and has one genuine advantage: it requires no local anaesthetic at all. On the face, two considerations pull the other way. The cold spreads outwards and downwards from the point of contact rather than stopping at a defined edge, so depth is less precisely controlled than with a tip or a blade. And the published comparison shows electrosurgery causes less hypopigmentation than cryotherapy, with electrosurgery preferred in darker skin types (Higgins et al., American Family Physician, 2015). Neither point rules it out — patients who strongly prefer to avoid an injection reasonably choose it — but it is a conversation worth having before treatment rather than after. Full detail: cryotherapy for skin tags.
Matching Method to Lesion
| Facial lesion | Usual approach | Reasoning |
|---|---|---|
| Small tag, narrow stalk | Scissor snip or fine hyfrecation | Seconds, no suture, frequently no visible mark |
| Tag with a broader base | Excision at the base | A superficial technique would leave base behind and it would return |
| Lid margin or lash line | Very fine snip with cautery, corneal protection in place | Depth control is critical next to the eye — see eyelid skin tags |
| Any lesion with atypical features | Excision with histology (£180) | Destructive methods leave nothing to examine |
| Patient who will not accept an injection | Cryotherapy, after discussing pigment risk | The only method requiring no anaesthetic |
The Argument That Outranks Cosmesis
“The real danger with skin tags is complacency. Occasionally something that looks like a tag is actually a basal cell carcinoma, a melanoma, or a neurofibroma, which is why I examine every lesion before removing it and send anything atypical for histology.”— Mr Onur Gilleard, Consultant Plastic Surgeon
This matters more on the face than anywhere else, because the face is where skin cancers are commonest. In the largest published series of lesions removed as presumed skin tags, five of 1,335 proved malignant on histology (Eads et al., Archives of Dermatology, 1996). One of those presentations is worth describing: a woman in her fifties attended to have a “skin tag” removed from her jawline that had been present about a year. It was not soft. It was firm and slightly pearly. It was excised and sent for histology, which returned a basal cell carcinoma — cured by that excision. Had it been destroyed in place, it would have recurred and the reason would not have been apparent.
Any method that destroys tissue — hyfrecation, cryotherapy, laser — forecloses that possibility. Where a facial lesion is firm, pigmented, growing quickly, bleeding without being caught, or simply unlike its neighbours, it is excised whole and examined rather than removed in place. That decision is made at the assessment, before any method is selected.
Aftercare, and the Part Patients Get Wrong
Whichever method is used, the healing site should be kept moist rather than allowed to dry into a hard crust, and left alone rather than picked. Significant scarring occurs in fewer than 2% of tag removals at this clinic.
The avoidable problem is sun. New skin pigments readily, and a healing facial site left unprotected through a summer will often darken in a way that has nothing to do with the surgery and everything to do with the following three months. Daily sun protection over the site for the first few months does more for the final appearance than the choice between snip and hyfrecation does.
The other avoidable problem is treatment taken too deep by an inexperienced operator, which trades a raised lesion for a pitted, sunken scar. That, rather than any particular technique, is the commonest cause of a disappointing facial result — described further in skin tag removal gone wrong.
Cost
| Item | Price |
|---|---|
| Consultation | £100 |
| Skin tag removal (first) | £200 |
| Each additional tag | £125 |
| Histology, where a lesion has suspicious features | £180 |
Pricing is the same whichever method is used, so the choice is clinical rather than financial. Assessment and treatment usually take place at the same visit: skin tag removal or contact the clinic.
Frequently Asked Questions
- What is the best way to remove a skin tag on the face?
- For most facial tags, a fine hyfrecator tip or a scissor snip worked slowly under local anaesthetic. Both control depth closely, take seconds per lesion and frequently leave no visible mark. Larger or broad-based lesions are excised at the base instead, and anything with atypical features is excised whole so it can be examined.
- Why is excision sometimes chosen over cryotherapy on the face?
- Because excision controls depth and margin precisely and preserves the lesion for histology, both of which matter more on facial skin. Cryotherapy is offered and is a reasonable choice for patients who wish to avoid an injection, but the cold spreads less predictably than a blade or a fine tip, and it carries a higher chance of pigment change.
- Will removal leave a white or dark mark on my face?
- Usually not. The specific risk with freezing is hypopigmentation, where cold damages pigment-producing cells and leaves a pale patch; published comparison shows this is less common with electrosurgery, which is preferred in darker skin types. Darkening afterwards is usually sun-related rather than surgical, which is why the site is protected while it heals.
- What about a tag on the eyelid or lash line?
- Those are removed with a very fine snip and cautery, performed with corneal protection in place or with the lid drawn away from the globe. As a plastic surgeon trained in eyelid surgery these are treated routinely; referral to an oculoplastic specialist applies only to lesions involving the lash line or lid-margin structures themselves.
- How likely is a scar?
- Significant scarring occurs in fewer than 2% of tag removals here, and a narrow-stalked tag removed by snip frequently leaves nothing visible. Excision leaves a fine line rather than a flat mark, which is the trade-off accepted for removing a broader lesion completely.
- Can a facial tag be tested after removal?
- Only if it is excised intact. Hyfrecation, cryotherapy and laser all destroy the tissue in place, leaving nothing to send to a laboratory. This is why the lesion is assessed first: where a diagnosis may be needed, the method is chosen to preserve it.
- Is it painful?
- Local anaesthetic is used for snip, hyfrecation and excision, so the removal itself is not painful; the only sharp sensation is the injection. Cryotherapy avoids the injection entirely and produces a cold sting lasting seconds.
- Can a facial tag come back?
- Not if it has been removed completely at its base. A lesion reappearing in the same spot within weeks generally means part of the base was left, which is more likely with a method that treats superficially. New tags forming elsewhere are a separate matter — see can skin tags grow back.
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