Anal Skin Tags 2025: The State-of-the-Art Treatment with Radiowaves and Lasers

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.

  

  The newest and best surgical CO2 laser on the market. LightScalpel 4020.

  

  The most precise laser beams from 0.25 to 0.4 to 0.8mm beams.

  

  Feels good and fits good in my hands. Just like a favorite Montblanc pen.

• 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

Very precise bipolar tips remove ASTs and control bleeding.

• 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

1a H&p Aesthetic Short Form Update 2023

87.5KB ∙ PDF file

Download

Download

This is the consent my staff and I review with you completely.

This is the Post Op Instruction Sheet to help with your recovery. You will be given my Private Patient Phone number that goes directly to me.

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 (red@alinsodinstitute.com, www.alinsodinstitute.com)

CASE STUDIES

ASTs at 12 O’Clock are the most common. They can be removed with RF and Lasers with excellent results.

A classic 12 O’Clock AST. My Bread and Butter case.

LightScalpel laser and radiofrequency can make the edges of the AST excision turn inwards and become undetectable without having to place sutures in most cases. Minimal pain and rapid gorgeous healing.

Another classic 12 O’Clock AST case removed using the LightScalpel laser without having to place sutures. The surgical site heals so well with the use of estrogen cream or exosome cream to generate normal new and soft anal skin.

This patient had a difficult time keeping her anal area clean because of the 12 O’Clock AST. The anal skin tag was irritating and not pleasing to look at. The ASTs were removed using the LightScalpel CO2 Laser.

This patient complained of a tough time keeping herself clean with stool getting caught behind the ASTs. She had them at 12 and 6 O’Clock on initial exam but the AST at 12 O’Clock actually took up the space between 6 to 2 O’Clock. Very deceiving. Look at the set below showing how it looks from several angles.

As mentioned on the photo set prior to this, what looks like a simple 12 O’Clock AST was actually taking up the space between 6 to 2 O’Clock as its attachment points. Photos patients send in are very helpful but not as good as an actual live physical exam. I always check before starting surgery.

This is a good example of an AST that travels from one side to the other. From 9 to 2 O’Clock. She loves her new anal appearance with the normal folds.

Another 9 to 2 O’Clock case that healed beautifully. No suturing is needed and the edges all pull inwards and new skin grows to cover the surgical site.

This patient complained of folds of skin on her perineum that continued down to her anal canal as skin tags. I performed a perineoplasty with removal of the AST at 12 O’Clock. She loved the pre baby look! Below’s photo is zoomed in.

This is the same case as above but zoomed in so you can see the beautiful perineal body and normal anal area. 12 O’Clock location once more.

This patient had an AST that started in her perineum that went all the way to the anal opening. Again it is at 12 O’Clock. She loved the results. See below as I spread the skin and get a better view of the extent of the AST.

I spread the area a bit and you can see the extent of the AST. You can also see how well the perineum healed at 6 weeks. You cannot tell any surgery was done when in its natural state. Healing can take up to 3 months in some cases.

This case is very similar to the prior case but this lady did not want the perineoplasty done. She only wanted the large 12 O’Clock AST removed. There were actually several smaller ASTs behind the large one and I removed all of them upon request. She is happy and feeling better. This picture shows lots of skin on the perineum but no more ASTs hanging w.

This is one of the times I needed to place sutures. I did a perineoplasty to remove all the extra skin on the perineum and to tighten the vaginal opening and make it look pre pregnancy once more. I then removed the AST at the 3 to 6 O’Clock and 10 to 12 O’Clock positions. A combo case that resulted in renewed confidence and a tighter vaginal opening. It is very common to do AST surgery at the same time as Labiaplasty and Vaginoplasty/Perineoplasty surgery.

This case shows an AST that is attached from about 5 O’Clock and wrapping around clockwise to the 2 O’Clock positions. Not quite all the way around but close. I used a LightScalpel laser and excised the large tag and placed no sutures. It healed up quite well with the use of estrogen cream and exosome cream in tandem. Our little secret to gorgeous healing that speeds up healing. The photo set below shows the same patient in various views.

This photo set is the same case as the one above and before it. No more ASTs. The natural skin folds are preserved.

This case shows an AST that almost goes around the entire anal opening but not quite. The ASTs are at 12 O’Clock and below at 3 to 8 O’Clock. I remove the ASTs with Laser or Radiofreuquency and then wait for the tissues to shrink inwards towards the anal canal that give it the pretty and petite anal folds that look natural and are easier to clean.

This case is a more difficult one to handle because the AST goes all the way around the anus and I call that a “Cauliflower Lesion.” Is does not look aesthetically appealing and it is tough to keep clean. It also destroys confidence during intimate times. This patient avoided intimacy. I used radiofrequency surgery to precisely excise perineal tissue. I used the LightScalpel to excise the ASTs. I had to place several sutures to recreate a pre pregnancy look of the perineum and anal area. Zoomed in photo below.

She had a beautiful result at 6 weeks post op with normal bowel movements, no pain, and increased confidence. She was not quite fully healed and I gave her instructions to continue the use of estrogen cream for healing and creation of new collagen and elastin in this anal area and to reduce that chance of scars. It worked very well and now she is about 1.5 years post op and happy.

This was a really tough case. First I had to do a vaginal tightening surgery then a perineoplasty to lengthen a very short perineal body damaged by childbirth. The “perineal body” is the space between the vaginal opening and the anal opening where episiotomies are cut. Once that repair was done and suturing approximated the edges I turned my attention to this Cauliflower lesion and used the LightScalpel laser to remove the ASTs and to shrink the tissues where it used to be attached to. That resulted in the inward shrinkage of tissues and a normal looking perianal area. The picture below shows the Before and After up close.

This is the Before and After a vaginoplasty, perineoplasty, and AST excision of a Cauliflower Lesion described in the previous photo.

A challenging Cauliflower Lesion that now looks normal. It will take another month for the full healing and color match of skin. There are no scars and BMs are normal without pain or bleeding. Notice how the edges really pull inwards and how normal and natural skin just grows on the previously raw looking wound site.

One last Cauliflower Lesion managed using the LightScalpel laser. The patient sent in the "After” photo on the right at 4 weeks post op and quite happy. Some patients heal very fast like her. I offer the use of PRP to aid in healing as well as the exosome cream that helps speed things along.

I received this award for creating Gynflix (online Cosmetic Gynecology e-Learning teaching) and probably for my ongoing and recent push to bring awareness and competence for the management of external Anal Skin Tags.

LightScalpel was recognized for its push into the Gynecologic fields for their surgical laser. I created the protocols for labial surgery and anal skin tag management for the company. Way to go LightScalpel!

Had to do my Matrix Look :-). I have presented talks on AST management for over a decade. Here I am in Antigua, Guatemala earlier in 2024. I developed and lectured on the LIghtScalpel CO2 Laser techniques since 2023. I have never taught this laser technique in my teaching programs until now via my online Gynflix platform. Surgeries only available in Dallas, Texas.

Feminine Wellness Newsletter

I hope you have enjoyed my newsletters and have learned some new things to improve your health. I always welcome your input and inquiries. Email me directly. Tell your friends and families about this Feminine Wellness Newsletter. I have over 21,000 subscribers and always appreciate the sharing our audience does to expand the reach of my writings. Much of the content is free and is released every few weeks. This is written for the Lay Public and Medical Professionals.

Visit GYNFLIX and see my hundreds of videos made for doctors. I have a special section called “Video Shorts” that is free and tailored for the Lay Public. Go here: SHORT

Gynflix is an online e-Learning platform dedicated to Feminine Wellness. Videos of topics such as labiaplasty, vaginoplasty, cliteroplasty, clitoral hood reduction, anal skin tag excision are shown in short snippets.

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DALLAS OFFICE
Alinsod Institute Dallas
Women’s Wellness Institute of Dallas
Preston Sherry Plaza
8201 Preston Road Suite 520
Dallas TX 75225
Phone: 945-900-7576 (Dian White, Medical Assistant)
EMail Dian White: dian@alinsodinstitute.com

Main Website: www.alinsodinstitute.com

I am happy to take care of you in Dallas!

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