Surgery Photo 1	Prep Picture 2
In this office procedure the Doctor puts a hemostat into in a paper drinking cup of shallow liquid nitrogen - it is being prepared while another hemostat is being used. .
As you can see there are skin tags to be treated on a childs hand.

This rapid skin tag removal treatment for small skin tags is to dip a hemostat, a nontoothed forceps, or a needle holder into liquid nitrogen for 15 seconds, and then to use that instrument to gently grasp the stalk of each skin tag for about 10 seconds. Care is taken to not touch the surrounding skin. The frozen tips of the instrument can treat up to about 10 lesions after being dipped in the liquid nitrogen. Pain level: 8

If a hinged instrument (such as a hemostat or needle-holder) is used, the level of liquid nitrogen (transferred to a paper or Styrofoam drinking cup that can be either hand-held or secured in a cup holder), should be shallow enough so that the hinge does not freeze. A second instrument can be freezing in the liquid nitrogen while the other is being used. I have not noted any rusting, corrosion, or performance problems with of any of the aforementioned instruments that I have used multiple times for the past 2 years.

The patient experiences only a very mild sting. The procedure results in little or no collateral damage to the skin, just a narrow rim of erythema. Multiple lesions can be treated by this method. No hemostasis or dressings are necessary. The frozen tag will be shed in approximately 7 to 10 days.

Figure 3	Figure 4
Here a pedunculated fibroepithelioma is being gently frozen with a needle holder.

Figure 5
This upper eyelid small skin tag can be treated with liquid nitrogen in a similar manner. There is no dripping, so the patient is able to lie down during the procedure.

This technique is especially useful for small pedunculated tags that hang on the eyelids (Skin Tag Photo# 4). In fact, the patient can lie down during the procedure since there is no dripping of the liquid nitrogen from the frozen instrument; whereas cotton-tipped application of liquid nitrogen can drip on the patient on unintended areas. Bulkier lesions are best treated with conventional methods.

Another setting is for the treatment filiform facial warts, particularly in apprehensive children (figs. 6 and 7). As with skin tags, the frozen wart is generally shed in 7 to 10 days; however, as with most warts, retreatment is often necessary.

Figure 6	Figure 7
According to the doctor, this 4-year-old child was very cooperative and allowed him to freeze these filiform skin tags repeatedly with a hemostat. She only required 3 return visits.