ENDOSCOPIC (SCARLESS) FOREHEAD SKIN LUMP REMOVAL

WHAT IS FOREHEAD SKIN LUMP?

• Forehead skin lump is a broad term that refers to any abnormal growth or bump that appears on the forehead area. Forehead skin lumps are fairly common. They can cause substantial social embarrassment and also physical discomfort with certain headgear.
• The nature of these skin lumps can be:
  • Lipoma
  • Osteoma

What is a Lipoma?

• Benign (non-cancerous) abnormal collection of fatty tissue growth within a thin fibrous capsule.
• Can be found in almost any part of the body.
• Complete removal is achieved when the lipoma is removed with the capsule.
• Usually soft, but over the forehead, lipoma tends to be deep and may feel firm.
• Usually does not resolve by itself. Treatment is by surgical removal.

 What is an Osteoma?

• Benign (non-cancerous) bony growth. Usually 1-2 cm in diameter. Feels bony hard.
• Can be found in many parts of the body.
• May be painful in some cases.
• Usually does not resolve by itself. Treatment is by surgical removal.

OPEN (TRADITIONAL) VS SCARLESS (ENDOSCOPIC) FOREHEAD SKIN LUMP REMOVAL

	Open (Traditional)	Scarless (Endoscopic)
Skin cut	Open Technique of forehead lump removal Direct skin cut over the skin lump	Endoscopic (Scarless) Forehead Lump Removal – no visible scar Two skin cuts hidden behind the hairline in the scalp.
Scar visibility	The scar may be pigmented in a dark-skinned individual.	The scar may blend with forehead wrinkles in older patients but is more visible in younger patients. Scar is hidden by the hair.
Technique	Direct cut and removal of the skin lump.	Special equipment is needed. A video endoscopic guides another cutting instrument to remove the skin lump remotely.
Patient Satisfaction	Average	Usually much better.

SUITABLE CANDIDATES FOR LIPOMA REMOVAL SURGERY

• Most patients are suitable for the technique except for those with a receding hairline.

DESCRIPTION OF SKIN LUMP REMOVAL SURGERY PROCEDURE

Endoscopic (Scarless) Forehead Lump Removal

• Tumescent fluid is injected into the forehead around the skin lump to separate the tissue layers. 
• Two small skin cuts (incisions) are made behind the hairline on the scalp. 
• A video scope is inserted to visualise the skin lump. 
• Another instrument is inserted via the second scalp incision to remove the skin lump under visualisation of the video scope. 
• Additional instruments may be needed to chisel or burr down a bony osteoma. 
• The skin lump removal surgery is usually completed within an hour. 
• Secure forehead bandaging is applied.

ANAESTHESIA

• Intravenous sedation or general anaesthesia.

POST SKIN LUMP REMOVAL SURGERY CARE

• Patients may go home the same day or stay overnight in the hospital.
• Forehead bandaging is to be worn for at least 3 days to reduce the risk of bruising over the forehead and around the eyes.
• Swelling and bruising usually resolves within about 2 weeks.
• Avoid exertion and rest at a 30 degree incline for optimal recovery.
• Apply antibiotic ointment to the scalp wound regularly 3-5 times a day.
• Pain is usually minimal and well controlled by oral medications.

RISK AND COMPLICATION OF SKIN LUMP REMOVAL SURGERY

• Bleeding and forehead haematoma (blood clot accumulation) (Risk minimised by adequate forehead bandaging)
• Small area of scalp numbness may take a few months to resolve.

FREQUENTLY ASKED QUESTION

Why do patients still choose scarless (endoscopic) forehead lump removal despite the increased cost?

Most patients would choose to avoid a scar over an otherwise flawless forehead whenever possible. The recovery time is comparable with the open technique, but the patient satisfaction level is much higher for the scarless technique. The patients who choose the open technique do so usually because of cost consideration or because they were not told of the scarless (endoscopic) option.

When is lipoma surgery recommended?

Lipoma surgery may be recommended if the lipoma or skin lumps are causing discomfort and emotional distress, or are located in a position that interferes with daily activities.

Does lipoma go away on its own?

Lipomas rarely go away on their own. Lipomas are Benign (non-cancerous) fat cells that form a lump under the skin. While they are usually harmless, they can sometimes cause discomfort. The most effective way to remove a lipoma is through surgical excision.

After the consultation, Dr Ng will assess if the forehead lump is a lipoma (fat) or an osteoma (bone). He will recommend the best surgical option for forehead lump removal – endoscopic scarless forehead lump removal or direct open method. The best surgical method remains scarless forehead lump removal which would also be recommended by top plastic surgeons in Korea or around the world.