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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A ganglion cyst is a jelly-filled swelling that balloons out from a joint capsule or tendon sheath — most often on the back of the wrist — connected to its source by a narrow stalk. That stalk is the whole story of ganglion treatment: needle drainage (aspiration) empties the cyst but leaves the stalk, and roughly half of aspirated ganglia come back. Formal surgical excision traces the cyst down to the stalk and removes it with a small cuff of joint capsule, bringing recurrence down to around 10–15%. At London Skin Clinic, ganglion removal is performed under local anaesthetic by consultant plastic surgeons with hand-surgery expertise, and costs £1,000 after a £100 consultation.
What a Ganglion Is — and Why It Keeps Refilling
A ganglion is not a true cyst like the skin cysts elsewhere in our library — it has no cell-lined capsule of its own. It is an out-pouching filled with thick, clear joint fluid (imagine cold honey), fed continuously from the joint or tendon sheath below through a one-way stalk. That plumbing explains everything patients notice: why it can shrink and swell with activity, why it sometimes vanishes and returns, and why any treatment that ignores the stalk is temporary. The classic site is the back of the wrist; the front of the wrist, the base of the fingers and the top of the foot follow. They are benign, often painless, and troublesome mainly when they ache with use, press on a nerve or simply look prominent.
Aspiration vs Surgery — the Honest Numbers
| Option | What it does | Recurrence | Our position |
|---|---|---|---|
| Leave it alone | Legitimate — some ganglia settle spontaneously | — | Reasonable for a painless, stable lump |
| Aspiration (needle drainage) | Empties the fluid; stalk remains | ~50% | We do not offer it as definitive treatment |
| Open surgical excision | Removes cyst, stalk and a cuff of capsule | ~10–15% | The definitive option |
Those aspiration numbers are why we are direct at consultation: draining a ganglion with a needle is quick and near-painless, and in about half of patients the lump is back within months, because the stalk quietly refills it. If you want the ganglion gone once, surgery is the treatment that addresses the cause.
The Operation, Step by Step
Ganglion excision at our clinic is open surgery under magnification — precision work rather than a quick shelling-out. Under local anaesthetic (a regional block for some wrist ganglia), the surgeon opens over the lump, traces the cyst down to its stalk at the joint capsule or tendon sheath, and removes the whole unit — cyst, stalk and a small cuff of the capsule it grew from. Removing the stalk is the key step: leaving it behind is what causes recurrence. The wound is closed with sutures and the whole procedure takes around 30 to 45 minutes. You are awake, comfortable and home the same day.
Recovery and Getting Your Hand Back
Recovery is quicker than most patients expect for hand surgery. Desk work is realistic within two to three days; sutures come out at 10 to 14 days; and the one firm restriction is no heavy gripping for about two weeks — gym bars, heavy lifting, racquet sports and stubborn jar lids all wait. After that, activity builds back as comfort allows. Wound care follows the same principles as our cyst aftercare guide: keep it clean and dry early, watch for spreading redness, and let the follow-up appointment do its job.
Who Needs Extra Care — and Who We Image First
Honesty about limits is part of good surgery. Volar wrist ganglia — on the palm side, where the cyst can sit against the radial artery — demand genuine hand-surgery expertise; at London Skin Clinic that is exactly what our consultant plastic surgeons have, so these are assessed and treated with the respect the anatomy deserves. Some situations go a different route entirely: ganglia in children, intraosseous ganglia (inside the bone), and any atypical lump — solid, fixed or fast-growing — get imaging before anyone operates, because “ganglion” is a diagnosis that must be earned, not assumed.
The Bible Method, Addressed Properly
Every ganglion thread eventually arrives at the folk remedy: smash it with a heavy book. Since patients genuinely ask, here is our surgeon’s verdict, on the record:
“It occasionally works, reliably hurts, and can fracture the wrist. I don’t recommend it.”
The mechanism, for the curious: a hard blow can rupture the cyst so the fluid disperses — the same result as aspiration, with the same refilling stalk left behind, plus bruising and a documented risk of breaking the very wrist you were trying to fix. The nineteenth century is welcome to keep this one.
Cost
- Consultation: £100 (separate, not redeemable)
- Ganglion excision: £1,000
- Histology, where indicated: £180
The fee reflects what the operation is: magnified, stalk-tracing hand surgery by a consultant, not a quick drainage. You receive the full cost in writing at the consultation — see our pricing page or book an assessment.
Frequently Asked Questions
- What is a ganglion cyst?
- A benign, jelly-filled swelling that balloons from a joint capsule or tendon sheath — most often the back of the wrist — and stays connected to it by a narrow stalk. It contains thick joint fluid rather than keratin, which is why it behaves differently from skin cysts: it can fluctuate with activity and refills through its stalk if merely drained.
- Do ganglion cysts go away on their own?
- Some do — spontaneous resolution is well recognised, which makes watchful waiting perfectly reasonable for a painless, stable ganglion. The ones that ache with use, press on nerves, or have persisted and grown are the ones worth treating definitively.
- Why not just drain it with a needle?
- Because roughly half of aspirated ganglia recur: drainage empties the fluid but leaves the stalk that produced it. We are happy to explain aspiration, but we do not offer it as definitive treatment — open excision that removes the stalk brings recurrence down to around 10–15%.
- Is ganglion removal painful?
- The operation itself, no — it is done under local anaesthetic or a regional block, so the area is completely numb. Expect post-operative soreness for a few days, managed with simple pain relief, and avoid heavy gripping for about two weeks while everything settles.
- Will the NHS remove a ganglion?
- Rarely for appearance alone — ganglion excision is classed as a procedure of limited clinical value in much of England, funded mainly when there is significant pain or nerve compression, and waits apply even then. It is one of the procedures patients most often fund privately.
- How much does ganglion removal cost in London?
- At London Skin Clinic, £1,000 for formal open excision under local or regional anaesthetic, after a £100 consultation — performed by consultant plastic surgeons with hand-surgery expertise. Histology, where indicated, is £180.
Ganglion Threads: What Reddit Asks, Answered by a Hand Surgeon
“Mine was aspirated twice and came back twice. Am I doomed to keep it forever?”
No — you have simply been having the treatment with the 50% recurrence rate, twice. A ganglion that returns after aspiration is the standard candidate for open excision: once the stalk and its cuff of capsule are removed, the odds flip from coin-toss to roughly 85–90% cured.
“It disappears for weeks then pops back up after the gym. What is it doing?”
Exactly what its plumbing predicts. The stalk works like a one-way valve from the joint; load the wrist and fluid is pushed through, rest it and the fluid slowly reabsorbs. The fluctuation is reassuringly typical of a ganglion — solid lumps do not do this — but it also tells you the connection to the joint is alive and well.
“Surgery scar vs the lump — is it a fair trade on the back of your wrist?”
A fair question with an honest answer: yes, there will be a fine scar, placed along natural skin lines and fading over months. Most patients who have lived with an aching or prominent ganglion consider a thin pale line the better deal — but for a small, painless lump that does not bother you, “leave it alone” remains a respectable choice.
More on cysts: every cyst type explained · skin cyst removal guide
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