Hello, I’m Dr. Hirotaka Kohrita,
director of Kohrita Hiro Orthopedic & Plastic Surgery Clinic
in Shin-Osaka, Osaka.
If you’re worried that “maybe this cyst can’t be cured anymore…”,
you are not alone.
Many patients visit our clinic after their cyst has returned
following surgery at another medical facility.
Even cysts that have recurred — or seem difficult to treat —
can often be cured completely using
punch excision combined with Natsui-style moist wound healing,
achieving beautiful, scar-free results.
To help you understand how we approach such cases,
let me introduce an actual example from our clinic.
💠 Recurrent Epidermoid Cyst after Surgery
at Another Clinic (Posterior Neck, Male in His 30s)
A man in his 30s noticed a foul-smelling lump on the back of his neck
and underwent surgery at another local clinic.
However, a few months later, the same area swelled again.
Concerned about recurrence,
he searched online for treatment options
and came to our clinic for a second opinion.
💠 “Can a Recurrent Cyst Still Be Treated by Punch Excision?”
Examination revealed that the cyst capsule (sac wall) had likely not been
completely removed during the first operation, leading to recurrence.
The patient asked:
“Can recurrent cysts also be removed by punch excision?”
The answer is yes — absolutely.
Even recurrent cysts can be completely removed using the punch excision method.
We have successfully cured numerous recurrence cases at our clinic.
💠 Surgery: Complete Removal by
Punch Excision + Moist Wound Healing
At the patient’s request, the recurrent cyst was completely excised,
including the entire capsule, using the punch excision technique.
The wound was then managed with Natsui-style moist wound healing,
our clinic’s standard approach.
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No disinfection was performed.
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No antibiotics were prescribed, as there was no infection.
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Showering and bathing were allowed from the next day.
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Normal daily life was hardly affected.
This method ensures minimal pain and beautiful healing.
📸 Intraoperative and Postoperative Photos
Preoperative view of an epidermoid cyst on the posterior neck (male, 30s). The cyst will be removed using punch excision with Natsui-style moist wound healing.
Intraoperative view of punch excision for a neck epidermoid cyst. A small circular opening is created with a biopsy punch before capsule removal.
Intraoperative view of punch excision for a neck epidermoid cyst. The cyst contents are being expressed through the punch opening.
Intraoperative view of capsule excision during punch excision for a neck epidermoid cyst. Complete removal of the capsule prevents recurrence.
Immediate postoperative photo after punch excision of a neck epidermoid cyst. Minimal bleeding is observed, and no complications are noted.
Specimen of a neck epidermoid cyst removed with punch excision. The capsule and contents were extracted in one piece to prevent recurrence.
Postoperative day 1 photo after punch excision of a neck epidermoid cyst. No bleeding or swelling is noted, and the patient reports no pain.
Postoperative day 4 photo after punch excision of a neck epidermoid cyst. The wound shows no infection, and the patient reports no pain.
Postoperative day 9 photo after punch excision of a neck epidermoid cyst. The wound is shallower, with no infection or pain observed.
Postoperative day 14 photo after punch excision of a neck epidermoid cyst. The wound is almost completely healed, with no signs of infection or recurrence.
Postoperative day 21 photo after punch excision of a neck epidermoid cyst. The wound has completely healed without infection, pain, or disinfection.
💠 One and a Half Years Later: No Visible Scar
The key to curing recurrent cysts is complete removal of the capsule.
About 18 months after surgery, the patient revisited our clinic
for treatment of another cyst.
We checked the previous surgical site on his neck.
1.5 years after punch excision of a neck epidermoid cyst. The scar is barely noticeable, with no pain, swelling, or recurrence.
Result:
The scar was virtually invisible,
and there were no symptoms or discomfort.
The patient kindly allowed us to take follow-up photos and said happily:
“Doctor, I can’t even tell where the surgery was done!”
💠 For Those Suffering from Recurrent Cysts
An epidermoid cyst tends to recur if even a small part of the capsule remains.
Many patients worry that their cysts are “uncurable” after recurrence.
However, with punch excision and Natsui-style moist wound healing,
we can treat recurrent cysts painlessly, cleanly, and definitively
— leaving almost no scar.
If you are troubled by the unpleasant odor, swelling,
or repeated recurrence of a cyst,
please feel free to consult us.
▶ See more actual cyst surgery cases here
💬 Frequently Asked Questions (FAQ)
Q1. Can recurrent cysts be treated by punch excision?
A1. Yes. By removing the entire cyst capsule,
we can significantly reduce the risk of recurrence.
Q2. Does the surgery hurt?
A2. Local anesthesia is used, so pain during surgery is minimal.
Most patients experience only mild discomfort afterward.
Q3. Are disinfection or antibiotics necessary?
A3. No. With Natsui-style moist wound care,
neither disinfection nor antibiotics are required.
Q4. How can I prevent recurrence?
A4. The key is complete removal of the capsule.
We have the expertise to fully extract the cyst wall,
even through a very small incision.
Our Philosophy: Natsui-Style Moist Wound Healing
The “Natsui-Style Moist Wound Healing“ method was
established by Dr. Makoto Natsui,
a highly respected Japanese plastic surgeon.
This approach avoids disinfection and gauze,
maintaining a moist wound environment to minimize pain
and promote natural,rapid healing.
Our clinic practices wound management based on
Dr. Natsui’s effective treatment philosophy.
▶ Official Website: “New Wound Treatment” by Dr. Makoto Natsui (Japanese)
▶Learn more about Natsui-Style Moist Wound Healing
🖊️ Author Information
Author: Dr. Hirotaka Kohrita
(Director, Kohrita Hiro Orthopedic & Plastic Surgery Clinic)
Specialties: Orthopedic surgery, plastic surgery, burn care, epidermoid cyst surgery
Experience: Over 6,000 total surgeries (approx. 500 per year),
with more than 1,000 clinical cases published on our official blog.
All cases are personally diagnosed, operated on, and followed up by the director himself.
