Video Interview: Surgical Techniques

Jennifer Holman, MD, discusses highlights from her lecture on Surgical Techniques at the 2021 Elevate-Derm Conference.

In this video

Dr. Holman, a Mohs surgeon in Tyler, Texas with nearly 14 years in practice, opens with her guiding rule: "be boring, don't be a unicorn." Doing the same thing the same way every time — the same steps, the same surgical tray, the same order — means you're less likely to miss something or make a mistake, and both you and your staff get more consistent outcomes. She likens it to a full body skin exam done top to bottom, in the same order, every single time, so the team can anticipate each step and be right there to help.

She also frames scar management as an expectations conversation that happens before you ever cut. Her "holey photo" — a picture of the defect taken before closure — resets patient expectations dramatically at follow-up, when they see the hole the scar came from. She stresses learning to "just say no" to certain cases and patients, and to reset expectations intraoperatively when a defect comes out larger than anticipated. Finally, she urges surgeons new to the OR to do their own suture removals — both to strengthen the patient relationship and to actually see what their wounds look like at two weeks versus three months, so they know when their technique needs to change.

• "Be boring, don't be a unicorn" — do the same steps in the same order every time so you and your staff get consistent, reliable outcomes.
• Scar education must happen before you ever create a scar; talk to the patient about the scar before you cut.
• Use a "holey photo" of the defect before closure — showing patients the hole it came from transforms their expectations at follow-up.
• Learn to "just say no" to the cases and patients that aren't right for you — and reset expectations intraoperatively when a defect is larger than anticipated.
• If you're new to surgery, do your own suture removals — it builds the patient relationship and lets you see whether knots pulled through or technique needs to change.