One of the things I think patients understandably worry about when considering facial surgery is scarring.

No surgery is truly scarless. Any time we make an incision through the skin, the body heals that incision with a scar. But as surgeons, we can often be very strategic about where that scar lives/ hides.

My patient shown is a young woman had a slowly enlarging lipoma of the upper forehead (a lipoma is a benign tumor composed of fatty tissue). Hers was located deep to the frontalis muscle, the paired muscle responsible for lifting the brows, in a tissue plane that normally contains little to no fat.  That anatomical location is a familiar surgical plane used in lots of brow lifting and reconstructive approaches to the forehead.

Instead of making an incision directly over the visible forehead bump, I approached the lipoma remotely through a small incision within the hair-bearing scalp. From there, I dissected through the natural tissue plane beneath the frontalis muscle to reach the lipoma and dissect around it while keeping the resulting skin scar concealed in the patient's hair.  My patient is shown 1 week after surgery, and is healing beautifully.

I want to show this patient to highlight one of my favorite principles in facial plastic surgery:  we can't eliminate scars, but we can often camouflage them.  Depending on the procedure and anatomy, that may mean hiding an incision within the scalp, placing it along the hairline, tucking it into the crease around an ear/ beneath the chin/ aligning it with an existing facial crease or natural transition between anatomical structures.

Of course, incision placement is only one part of scar quality.  Tissue handling, closure details, genetics, age, sun exposure, nicotine use, postoperative wound care, and simply giving the scar enough time to mature all matter.  But whenever anatomy gives me the opportunity, I would much rather hide a scar than ask a patient to stare at it every day.

Happy to answer questions about my patient's treatment, and head and neck lipoma treatment :-)

Forehead Lipoma Excision [surgeon post]