Cortisone Injection vs Surgical Excision

Cortisone Injection: A tiny shot of diluted steroid into one inflamed acne cyst. It flattens that spot in a few days. It treats the bump, not the acne.

Surgical Excision: The growth is cut out along with a measured border of normal-looking skin, and the wound is stitched closed. The whole piece goes to a laboratory and the result comes back in about a week. The scar is a line, and it is longer than the spot was.

Reviewed by Dr. Schwarz, Board-Certified Dermatologist
Last updated: 10/22/2026

Editorial illustration for Cortisone Injection, based on the entry’s treatment or equipment reference.

Editorial illustration for Surgical Excision, based on the entry’s treatment or equipment reference.

Choose if Key differences What is it?What it treats Treatment areas Skin tones How it works Before your treatment Day of treatment After your treatment Risks Cost Questions Related

Choose Cortisone Injection if…

Choose for one painful acne cyst that needs to flatten fast, or for keloids and patchy hair loss.

A single painful cyst before an event
A raised keloid
A patch of alopecia areata

Choose Surgical Excision if…

Choose to remove a skin cancer or suspicious growth completely with lab-checked edges — the scar is a line, longer than the spot.

Melanoma or a suspicious mole
Skin cancer on the trunk or limbs
You want the whole growth checked

Often combined

Can you have both?

For keloids, cortisone injections are often given after excision to stop the keloid regrowing.

Key differences

● Cortisone Injection

● Surgical Excision

DowntimeNone → 2+ weeks

None

1–2 weeks

PainMinimal → Needs anesthesia or sedation

Mild

Results showImmediately → 3+ months

Within days

Immediately

How long it lastsWeeks → Years or permanent

Weeks

Years or permanent

Visits neededOne → Every few months

Every few months

One

Cost per visit$ → $$$$$

ReversibleYes, can be undone → No, permanent

No, permanent

What is it?

Cortisone Injection

Surgical Excision

What is it?

It is injected into a lesion.

An intralesional steroid calms local inflammation or scarring.

It differs from joint injections.

It is not a systemic steroid treatment.

The diagnosis matters.

Infected or uncertain lesions should not be injected.

Side effects can last.

Skin thinning, fat loss and pigment change may persist.

It removes a lesion surgically.

A planned incision removes the lesion and a rim of tissue.

It diagnoses or treats.

It provides tissue or removes a known lesion.

Margins depend on the diagnosis.

They should not be chosen from a generic chart.

Mohs is different.

Standard excision and Mohs assess tissue differently.

What it treats

Evidence level

Cortisone Injection

Surgical Excision

Strong evidenceMost established uses

Acne

Flattens a painful cyst within days.

A raised, smooth, firm scar on the upper chest on light skin. It is shiny pink-red and hairless, and its edges spread well past the small mark it grew from.

Keloids

Softens and flattens raised scars.

Alopecia Areata

Regrows hair in patches.

Basal Cell Carcinoma

High cure rates.

AI-generated educational illustration: Crusted red raised lesion on a light-skinned sun-exposed hand.

Squamous Cell Carcinoma

Removes the cancer with margins.

Melanoma

The main treatment.

A smooth, dome-shaped lump about two centimetres across on the upper back on pale skin, with a tiny dark pore at its center and faintly pink skin over it.

Epidermal Inclusion Cyst

Removes the sac.

Moderate evidenceSome supportive research

Epidermal Inclusion Cyst

Calms an inflamed cyst.

—

Little evidence

—

Acne Scarring

Punch excision is used for small scars instead.

Not effective

dark keratin plugs in dilated pores on the nose and adjacent left cheek, with the face turned to the person’s right on light skin.

Blackheads

Not for clogged pores.

—

Can make it worse

Acne Scarring

Can cause dents in skin.

Keloids

Keloids often return larger alone.

Treatment areas

The specific lesion, scar or affected patch determines the treatment site; there is no fixed body distribution.

Skin tones

Skin tone

● Cortisone Injection

● Surgical Excision

Lighter skin

Low risk

A small dent is possible.

Low risk

A fine line scar.

Medium skin

Some risk

Lighter patches can show.

Low risk

Scar fades over a year.

Deeper skin

Some risk

Lightening and dents are more visible; low doses help.

Some risk

Raised or keloid scars possible, especially on chest, back and shoulders.

How it works

Cortisone Injection

Surgical Excision

How it works

Cortisone Injection mechanism diagram. Medicine is placed in a lesion: A clinician injects an appropriate corticosteroid preparation. Inflammatory signaling decreases: The steroid reduces local immune and inflammatory activity. The lesion may soften or flatten: Response depends on the condition, dose, and placement.

Surgical Excision mechanism diagram. The area is planned: Diagnosis and location guide the removal border and depth. The lesion is cut out: The clinician removes the selected tissue as a specimen. Closure and tissue review follow: The wound heals, while pathology helps guide further care.

Diagram explanation

Medicine is placed in a lesion: A clinician injects an appropriate corticosteroid preparation. Inflammatory signaling decreases: The steroid reduces local immune and inflammatory activity. The lesion may soften or flatten: Response depends on the condition, dose, and placement.

Schematic illustration. Technique and response vary. This explains a mechanism and does not specify treatment settings.

The area is planned: Diagnosis and location guide the removal border and depth. The lesion is cut out: The clinician removes the selected tissue as a specimen. Closure and tissue review follow: The wound heals, while pathology helps guide further care.

Schematic illustration. Technique and response vary. This explains a mechanism and does not specify treatment settings.

Before your treatment

Cortisone Injection

Surgical Excision

The week before

Do not pick: Do not pick, squeeze or heat the spot.

Supplements and alcohol: Non-essential blood thinners such as fish oil, vitamin E and ginkgo are commonly stopped about a week before, and alcohol the night before.

Smoking and vaping: Stop for a week before and two weeks after if you can.

Day of treatment

Cortisone Injection

Surgical Excision

Before you arrive

Clean skin: Wash your face and skip makeup on the area.

Eating and clothes: Eat normally and take your usual morning medicines.

Arrival & prep

The provider checks that the spot is an inflamed acne cyst and not a boil.

The site is confirmed against the biopsy report and you point to it yourself.

Treatment

The skin is wiped with alcohol.

A very fine needle goes just into the bump and a small amount of fluid goes in, under 10 seconds per spot. The sting is sharp for a few seconds, worse if the cyst is already tender, but most people rate it lower than they expect. Numbing does not help much — the needle stick is the whole procedure.

The surgery: The skin is cleaned and draped.

The surgery: The ellipse is cut out in one piece, bleeding points sealed, and the edges freed so they meet without tension. Closing is in layers — dissolving stitches deep, stitches on the surface. You feel pressure and tugging and hear instruments, but nothing sharp. Most take 20 to 45 minutes, and the site feels tight afterward rather than sore.

Before you leave

A tiny red dot, sometimes a small raised bleb that flattens within an hour.

A dressing, written wound care, a stitch removal appointment, and a plan for how the pathology result reaches you.

After your treatment

Cortisone Injection

Surgical Excision

First 24 hours

Days 1 to 2: The bump softens and the ache fades.

Not specified

Days 2–7

First few days: A pinprick mark, sometimes a small bruise, fading over a few days.

Days 3 to 7: Most cysts are flat.

First week: Keep the dressing dry and in place for 24 to 48 hours, then start daily care — gentle wash, petrolatum, non-stick dressing.

Days 5 to 14: Stitches come out — face at 5 to 7 days, trunk and arms at 10 to 14, legs and back sometimes longer.

Weeks 2–4

Not specified

From week 2: The scar is hardest, pinkest and most raised at around three to six weeks.

Time to results

24–48 hours for a cyst

Lab result in about a week

How long results last

Treats only that spot

Permanent

Risks

Dent in the skin
Lighter patch of skin
Visible small vessels

A thick, raised or widening scar
Numbness or a firm cord under the skin
A stitch that surfaces months later
A margin that was not clear
A pucker at one end of the line
When to contact your provider

Cost

Per session

Roughly $50 to $250 per office visit in the US, usually billed as an office visit plus a procedure charge rather than per spot.

An excision costs more than a scrape-and-burn and less than Mohs surgery.

Insurance

Insurance often covers it, since acne cysts count as medical rather than cosmetic.

In the US the surgical charge is priced by the size of the excision and the body site, with a separate charge for a more complex layered closure.

Questions

Cortisone Injection

Surgical Excision

Individual Questions

How fast does a cortisone shot work on a cyst?

Softening begins within 24 to 48 hours and most spots are flat by day three to five. That figure traces back to one small 1983 trial — it matches what dermatologists see but has never been tested at scale. The mark left behind takes weeks longer, and the injection does not speed that up.

Will it leave a dent?

It can. A shallow depression happens when the dose is too strong, so a lower concentration is the main protection. It is uncommon — most dermatologists see it in well under one patient in a hundred — and it often fills in over several months. But it is not reliably temporary. About half the clinicians who do see it report it lasting more than six months, and occasionally it is permanent. That is why you ask what concentration is being used.

Can I get one before an event?

Yes, the most common reason people ask. Aim for three to five days ahead so the swelling has time to drop. A same-day injection rarely looks better by that evening.

Does it stop acne from coming back?

No. It treats only the spot it is injected into. Preventing the next cyst needs a daily treatment plan, and the guidelines call this an add-on.

Is it safe on deeper skin tones?

Yes. The risk is a lighter patch at the site, more noticeable and slower to fade on deeper skin tones. A lower concentration reduces it, so ask.

Is this approved for acne?

Not in the United States, strictly speaking. The FDA labeling lists intralesional use for keloids, alopecia areata, discoid lupus and others. Acne is not on it. Off-label use for an acne cyst is routine, legal and recommended by the American Academy of Dermatology, but almost nobody says it out loud. In the UK, NICE withdrew its recommendation in 2026 after UK-licensed triamcinolone injections stopped being available — a supply and licensing decision, not a safety one.

Why is the scar so much longer than the spot?

Because a round hole cannot be closed flat. The piece taken out is an ellipse roughly three times as long as it is wide, so the edges meet evenly instead of puckering at each end. A spot the size of a pencil eraser becomes a line an inch or more long. It is geometry, not technique, and no surgeon avoids it.

How long until I get the result?

Usually 3 to 10 days, depending on the laboratory. Ask before you leave how and when you will be told, and call if you have heard nothing after about two weeks.

What happens if the margins are not clear?

A further procedure — a re-excision with a wider border, or a referral for Mohs surgery — usually within a few weeks. It is not a mistake. It is the reason the specimen went to a laboratory in the first place.

When can I exercise again?

About 2 weeks for most sites, longer for the back, shoulder and shin. The visible stitches come out sooner, and the deep stitches are still carrying the tension. Lifting or straining is what stretches or splits a wound.

Should I have Mohs surgery instead?

On the face, particularly the nose, eyelids, ears and lips, or for a tumor that is large, has vague borders, has an aggressive subtype on the biopsy, or has come back before, Mohs is often better. For a small low-risk cancer on the trunk or limbs, an excision achieves the same result in a fraction of the time and cost. Ask which category yours is in.

Will the scar fade?

It flattens and pales substantially over about a year, with most of the change in the first six months. Keeping it out of the sun and using silicone gel or sheeting once it is closed are the two things with reasonable evidence behind them. Scars on the chest, shoulders and upper back stay red and raised longest and are the likeliest to widen.

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