Q: Dr. Eppley, I would like to know whether you, in principle, perform endoscopic surgery for the removal of forehead lipomas. This is because I understand that some doctors use the endoscopic method for the removal of osteomas only, believing that using the technique on lipomas cause too much tissue trauma. I wonder what is your position on this issue.
A: In answer to your question, most forehead lipomas can be removed with an indirect approach using a hairline incision if one wants to avoid a direct scar over it. While an endoscopic technique can be used, it usually offers little benefit and does require the elevation of much more forehead tissue off of the bone than the hairline approach does.
However the further forehead lipoma is from the hairline, like down at the eyebrow area for example, it may not be possible to remove it from a hairline incision. This is where the endoscopic can have a role in its removal. A guideline to use is if the lipoma is below the ‘equator’ of the forehead the endoscopic technique will be needed. But if it sits north of the imaginary horizontal line it can be removed through a hairline incision.
Dr. Barry Eppley