Forehead Lipomas Research Articles

Scar Avoidance in Removal of Forehead Lipomata: An Endoscopic Approach

Lipomas are among the most commonly presenting benign forehead masses. They commonly cause cosmetic concerns for patients. The purpose of this report is to introduce a novel endoscopic technique allowing for forehead soft tissue mass removal with superior cosmetic outcomes. We detail a case of a large 3.5-cm lateral forehead lipoma that was successfully removed endoscopically through a single incision via a subtemporoparietal approach. The lipoma presented is the largest documented case removed endoscopically using this approach. We introduce a novel technique using a single incision in the temporal area to remove a forehead mass via a dissection between the temporoparietal fascia and deep temporal fascia. Our broad literature search only found one other report of this approach used for forehead lipoma removal. Our report further validates this approach and highlights its efficacy in removing large masses. Patients with cosmetic concerns about having a facial scar, children, and those with predisposition for keloids or hyperpigmented/hypertrophic scars stand to benefit most from this procedure. When comparing the endoscopic approach with the commonplace open-incision approach, our approach shows superior cosmetic results, less risk of damage to important neurovascular structures, and, most importantly, higher patient satisfaction. Even when contrasting the technique outlined in this report versus other endoscopic approaches, our method produces enhanced results.

Stealth surgery: Subcutaneous endoscopic excision of benign lesions of head, neck and trunk in children.

BACKGROUND:Subcutaneous endoscopic excision of benign lesions of the head, neck and trunk is a new dimension in paediatric minimally invasive surgery. This study is a case series where cases are operated endoscopically with minimal scars.PATIENTS AND METHODS:This is a prospective study where in 13 patients who underwent Stealth surgery were enrolled in this study. Factors such as intraoperative time, blood loss, intraoperative complications, postoperative recovery and appearance and placing of minimal scars at inconspicuous sites were taken into consideration.RESULTS:All patients underwent successful surgery without converting to open surgery. Out of 13 patients, five were torticollis, four were suprasternal dermoid, one had chest wall swelling, one had swelling of arm, one had back lipoma and one had forehead lipoma. The mean operation time was 50 min (range 32-70). All patients were followed up regularly postoperatively. All patients were operated as daycare, less postoperative pain, no evident scars, lower complications related to scars.CONCLUSION:Subcutaneous endoscopic surgery addresses concerns related to scarring by replacing large visible incisions with smaller incisions placed in inconspicuous locations. This is a safe and effective procedure of early recovery.

Forehead lipoma excision: a comparative study of open versus endoscopic technique

Endoscopic excision of forehead lipoma is increasingly utilized for its inconspicuous scarring, good intraoperative visualization and low complication rates. Currently, studies comparing outcomes from endoscopic and open excision of forehead lipomas are lacking. This retrospective study compares the surgical outcomes of the two techniques. The authors retrospectively reviewed medical records of all patients who had undergone forehead lipoma excision at a single institution between 2010 and 2015. Data collected included patient demographics, lesion size, mean operative time and postoperative complications. A comparison was made between the two groups of patients. Sixty-two patients underwent excision of their forehead lipoma (38 endoscopic and 24 open excisions). Patient groups were similar in terms of sex ratios, size of lesion, choice of anaesthesia, mean operative time and duration of follow-up. Swelling beyond 1 week in the endoscopic group was 1/38 (2.6 %) compared to 4/24 (16.7 %) in the open excision group (p = 0.07). Postoperative scalp numbness in the endoscopic group was 2/38 (5.2 %) versus 2/24 (8.3 %) in the open excision group (p = 0.64). Incidence of haematoma in the endoscopic group was 1/38 (2.6 %) compared to 2/24 (4.2 %) in the open excision group (p = 1). All 38 patients in the endoscopic group were satisfied with their scars compared with 4/24 (16.7 %) in the open excision group who reported dissatisfaction (p = 0.02). Complication rates of both surgical techniques are similar. Given that the endoscopic technique results in cosmetically superior outcomes, with no increase in morbidity, the authors recommend the use of endoscopic technique for forehead lipoma excision. Level of Evidence: Level III, therapeutic study.

The Accuracy of Ultrasonography on the Location of Lipomas in the Forehead.

Preoperative recognition of tumor plane is important to avoid surgical complications in surgeries involving the scalp. Ultrasonography is a useful diagnostic tool to detect the depth of tumor noninvasively. However, some findings are not always in accordance with the actual locations of lipomas, especially in the forehead. To evaluate the accuracy of preoperative ultrasonographic findings for the location of lipomas in the forehead. The study included 14 patients with lipomas in the forehead who all underwent preoperative ultrasonography and surgical excision of the lesions. The authors compared the diagnostic location of tumors by ultrasonography with the actual location in the surgical field. On ultrasonography, 10 of 14 cases were diagnosed as frontalis-associated lipomas. However, 13 cases were confirmed as frontalis-associated lipomas intraoperatively, and only 1 case as superficial lipoma, which did not correspond with the ultrasonographic finding. The ultrasonographic findings were accurate in 9 of 14 cases (64.3%). The accuracy of ultrasonography on the location of lipomas in the forehead is not as high as expected. Therefore, the surgeon must consider the possibility of deep lipoma even if a forehead lipoma is superficial in location on ultrasonography.

Successful treatment of forehead lipoma depends on knowledge ofthe surgical anatomy: a step-by-step guide.

We review the anatomy of the frontal scalp in relation to the clinical features and surgical management of frontalis-associated lipoma. Awareness of this entity, coupled with sound regional anatomical knowledge, is essential to achieve good outcomes.

Clinical Characteristics of the Forehead Lipoma.

BackgroundLipomas can be categorized into deep and superficial lipomas according to anatomical depth. Many cases of forehead lipomas are reported to be deep to the muscle layer. We analyze ultrasound in delineating depth of forehead lipomas.MethodsA retrospective review was performed for all patients who underwent excision of forehead lipomas between January 2008 and March 2013 and for whom preoperative ultrasound study was available. Sensitivity and specificity of ultrasound imaging was evalauted against depth finding at the time of surgical excision.ResultsThe review identified 42 patients who met the inclusion criteria. Preoperative ultrasound reading was 18 as deep lipomas and 24 as superficial. However, intraoperative finding revealed 2 of the 18 deep lipomas to be superficial and 13 of the 24 superficial lipomas to be deep lipomas. Overall, ultrasonography turned out to be 69% (29/42) accurate in correctly delineating superficial versus deep lipomas.ConclusionLipomas of the forehead tend to be located in deeper tissue plane compared to lipomas found elsewhere in the body. Preoperative ultrasonography of lipomas can be helpful, but was not accurate in identifying the depth of forehead lipomas in our patient population. Even if a forehead lipoma is found to be superficial on ultrasound, operative planning should include the possibility of deep lipomas.

Endoscopic Excision of Forehead Lipomas

Objective: Describe a method of endoscopic forehead lipomas that results in minimal visible scarring and good cosmetic results. Method: We present a retrospective case series of 4 patients who presented with forehead lipomas from July 2009 to December 2011. Patients underwent endoscopic excision of the lipomas using pretrichial incisions and standard endoscopic brow instrumentation. Outcomes measured were cosmetic results, presence of a depressed scar, and postoperative complications. Results: All patients had good cosmetic results with no depressed scars and no postoperative complications. Conclusion: Endoscopic excision is an effective, minimally invasive, and cosmetically satisfying approach to forehead lipomas in the population who desires to avoid a visible scar.

‘Scarless’ removal of forehead lipomas

‘Scarless’ removal of forehead lipomas

'Scarless' removal of forehead lipomas

'Scarless' removal of forehead lipomas

Endoscopic and ultrasonic removal of a lipoma on the forehead with no facial scarring: Practicality of patient's early return to work

We used endoscopy and ultrasonic liposuction to remove lipomas from the forehead to facilitate early return to work. The tumours were approached through a pair of small remote scalp incisions behind the frontal hairline, which continued to subperiosteal dissection, thereby avoiding injury to the supraorbital or supratrochlear neurovascular bundles. The deep surfaces of the lipomas were identified easily through the periosteum by well-illuminated and magnified endoscopic views, and protruded through the periosteal incisions. An ultrasonic cannula was introduced to emulsify and aspirate the lipomas. Parts of the lipomas were extracted by forceps as solid specimens for histopathological evaluation. Preservation of the neurovascular bundles and complete resection of the tumours in the bloodless operative fields were confirmed by direct endoscopic monitoring. Of five patients treated, three returned to their jobs within two postoperative days, with no protective dressings on their faces. There have, to our knowledge, been few reports describing this combination of endoscopy and ultrasonic treatment of forehead lipomas.

Symptomatic cluster-like headache triggered by forehead lipoma: a case report and review of the literature

We describe the case of a patient with symptomatic strictly unilateral paroxysmal headache mimicking cluster headache related to an ipsilateral forehead lipoma. Interestingly, immediately after the surgical excision of the lipoma pain attacks disappeared with no recurrence during a follow-up period of 18 months. Like other descriptions of cluster-like headaches secondary to extracranial lesions, this case report focuses on the hypothetical role of a peripheral trigger factor for trigeminal autonomic cephalgias (TACs). To our knowledge, this is the first well-described cluster-like headache case secondary to an extracerebral lipoma. This case offered the opportunity to discuss the possible pathophysiological mechanisms underlying probable TACs and the relationship with peripheral extracerebral activation of the trigeminal-autonomic reflex.

Endoscopic resection of forehead lipoma: A subperiosteal single-portal approach

ABSTRACTForehead lumps which are commonly excised for cosmetic reasons, are done through a traditional open excision technique. In the Asian population, open excision commonly results in a pigmented scar which tends not to fade with time and this can be a concern to some patients. The aims of this paper are to describe an endoscopically assisted technique of surgery, with emphasis on the subperiosteal, single-portal approach; to review the outcome of the surgery, and to define the indications for its use. Materials and Methods: We describe here a case series of ten patients, in whom a minimally invasive technique was employed for the removal of a forehead lipoma via an endoscopic, single-portal, subperiosteal approach. Results: The patients′ age ranged from 26 to 54 years and the dimensions of the masses removed ranged from 1.0 x 0.5 cm to 3.0 x 3.0 cm. All were confirmed by histological examination to be lipomata. The patients were followed up for an average period of nine months. There were no residual masses or recurrences and no complications of nerve damage. All the patients were very satisfied with their ′scar less′ operations. Conclusions: Endoscopic excision of forehead lipomas through a single-port approach is both safe and reliable. It is indicated in patients who are prone to scarring or who are concerned with a forehead scar.

Endoscopic excision of forehead lipomas

Endoscopic excision of forehead lipomas

Endoscopic resection of forehead lipoma: A subperiosteal single-portal approach

Forehead lumps which are commonly excised for cosmetic reasons, are done through a traditional open excision technique. In the Asian population, open excision commonly results in a pigmented scar which tends not to fade with time and this can be a concern to some patients. The aims of this paper are to describe an endoscopically assisted technique of surgery, with emphasis on the subperiosteal, single-portal approach; to review the outcome of the surgery, and to define the indications for its use.Materials and Methods:We describe here a case series of ten patients, in whom a minimally invasive technique was employed for the removal of a forehead lipoma via an endoscopic, single-portal, subperiosteal approach.Results:The patients' age ranged from 26 to 54 years and the dimensions of the masses removed ranged from 1.0 × 0.5 cm to 3.0 × 3.0 cm. All were confirmed by histological examination to be lipomata. The patients were followed up for an average period of nine months. There were no residual masses or recurrences and no complications of nerve damage. All the patients were very satisfied with their ‘scar less’ operations.Conclusions:Endoscopic excision of forehead lipomas through a single-port approach is both safe and reliable. It is indicated in patients who are prone to scarring or who are concerned with a forehead scar.

Post-traumatic pseudolipoma of the forehead

A forehead lipoma is a rare finding in a child, and one that penetrates the underlying layers of muscle and bone to attach to dura has not previously been reported. Two such cases, both in children who underwent uneventful deliveries aided by forceps, are presented. Both lesions were present at birth and, based on clinical findings, were originally thought to be dermoid cysts. Dermoid cysts could not be ruled out with computed tomography and magnetic resonance imaging. Histopathology identified fibrofatty tissue consistent with lipoma. Both lesions extended from the subcutaneous tissue through the frontalis muscle and frontal bone to the dura. Given these findings and the history of forceps delivery, the most likely diagnosis is post-traumatic pseudolipoma. This lesion should be considered in the differential diagnosis of congenital lesions of the forehead, particularly if there is a history of forceps delivery or other trauma to the area.

Forehead lipoma resection via a small remote incision using a surgical raspatory

Lipomas are benign tumors and, therefore, a surgical technique that does not leave a visible scar would be an ideal method. A forehead lipoma can be extracted using a small remote incision with endoscopic assistance for aesthetic purposes. However, endoscope-assisted surgery is usually technically demanding, time-consuming, and less cost-effective. In this report, we propose an alternative approach to the surgical resection of a forehead lipoma with a small remote incision. Our method uses a surgical raspatory. Our technique allows the complete removal of the lipoma with no complications using a raspatory passed down a subcutaneous tunnel from an incision placed in an aesthetically advantageous site.

Endoscopic excision of forehead lipomas

Endoscopic surgery is a significant addition in the maxillofacial surgeon's armamentarium. Authors’ experience of endoscopically assisted removal of forehead lipomas has been presented. The endoscopic technique permits to hide minimal scars in the hair. The magnification allows a good identification of anatomical structures and thus decreases the risk of numbness. The main disadvantages of this technique are the more expensive equipment and the steep learning curve. But with the expansion of endoscopic techniques, prices should decline and the duration of operations always lessens with experience. This technique might possibly appear to offer a new standard procedure for removal of forehead lipomas, notably in patients with keloid history or high aesthetic concerns.

Another indication for liposuction: small facial lipomas.

The treatment of facial lipomas at times requires the use of incisions that are less than satisfactory in either size or location. In an effort to minimize scarring, the authors have been removing these lesions with liposuction. The purpose of this study was to review the authors' experience in treating small facial lipomas using liposuction. Over the last 10 years, the authors treated five patients with forehead lipomas by removal with liposuction through hair-bearing scalp incisions. All patients were evaluated after the procedure for bleeding, paresthesias, recurrence, scarring, and overall satisfaction with the procedure. All of these patients had lipomas that measured 4 cm or less at the time of surgery. No patient experienced hematoma, nerve injury, or recurrence. All patients were completely satisfied with their result and scar. The literature describes an advantage to using liposuction for the treatment of medium (4 to 10 cm) and large (>10 cm) lipomas. Because small lipomas (<4 cm) can be extracted through small incisions, the literature reports no advantage to removal with liposuction. However, favorable aesthetic results can be obtained by removing small facial lipomas with liposuction through strategically placed incisions.