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Endoscopic scarless forehead lump removal

What causes forehead bumps?

Bumps on the forehead are a relatively common problem. More often than not, they are caused by an acute injury leading to bleeding causing a bruise or hematoma. With proper first aid and time, these commonly resolve on their own within 1-2 weeks. Occasionally, the bleeding can track down to the upper eyelids leading to swelling in the region around the eyes. This should not be cause for alarm. In other instances, bumps on the forehead can be due to an infection, which is associated with skin changes and redness and should be treated expediently with antibiotics and possibly a procedure to drain the abscess.

Bulges on the forehead that last for more than a couple of weeks could be a cause for concern, and advice should be sought. They can arise in any of the connective tissue structures of the forehead including the skin, muscle and bone. Lumps arising from the skin and muscle include benign skin growths, scar tissue lumps, skin cancers, cysts, and lipomas (there are abnormal, localized fatty deposits). Lumps arising from the bone include benign as well as malignant tumors, or from infections arising deep to the skull bone itself. Benign bone lumps are also known as osteomas.


What is an osteoma?

The most common form of benign bone tumors are osteomas. These tumors typically form on any part of the skull, and usually do not cause symptoms until they exert localized pressure. This can lead to clinical features such as headaches, compression on the nasal passageway or eye, facial pain, and most commonly on the forehead, an unsightly bump. The exact cause of osteomas is as yet unknown, but it could be due the skull bone’s reaction to injury and trauma. In very rare instances, they could be associated with syndromes which involve other benign and malignant tumors.

How do I get rid of that bump on your forehead?

Treatment for forehead bumps is dependent on the underlying cause. With bruising, bleeding or hematoma, often times simple rest, ice and compression as well as anti-inflammatories can help with quicker resolution. In instances of infection, an aspiration or incision and drainage procedure may be required. This is often accompanied with a course of antibiotics.

In cases of more lingering bumps, removal of the bump may be the only option. This can be done when the bumps cause symptomatic issues such as pain, when there is suspicion of malignancy, or when it causes concern for cosmesis.

The method of removal can be through open or closed excisional techniques. Simply put, open excisional techniques involve excising the bump through a linear or elliptical skin incision. These incisions can quite often be well hidden in existing forehead lines or at the hairline. In more elderly patients, the resultant scar quite easily blends into the forehead wrinkles. Plastic surgeons are well trained to combine knowledge of skin tension and meticulous surgical technique to minimize scarring from these procedures.

In some instances, the bump may be amenable to a scarless removal technique known as endoscopic forehead removal. The bumps where this is an option include lipomas and osteomas of the forehead, along with a few other benign forehead lesions.

What is endoscopic scarless forehead lump removal and how is it performed?

This technique of lump removal is performed through two to three 1-2cm incisions in the hairline, thus negating any visible scars, which is its distinct advantage.

This procedure is ideal for patients with a good crop of hair and without a receding hairline, and where the forehead is not extremely convex. Prior to the procedure, your surgeon may order a scan of the head to determine the exact position of the lump and help to rule out more sinister growths.

The procedure can be performed under local anaesthesia with sedation or general anesthetic. Using an endoscope (a telescopic camera) as well as long instruments such as an osteotome, elevator and forceps, forehead lumps as far away from the hairline as the brow region can be removed with this technique. The endoscope allows close up visualization and removal of the lump. The incisions in the hairline are closed meticulously to minimize any hair loss along the scalp. Scars are completely inconspicuous.

After the procedure, a secure forehead dressing and bandage is applied to reduce swelling and aid recovery. In the initial few days after the procedure, there may be some bruising which tracks downwards to the region around the eyes. Complete recovery is relatively swift, often within 2 weeks.

There are few contraindications to endoscopic forehead lump removal. If the lump is close to the hairline, the use of the endoscope may be negated as it may be amenable to removal under direct vision via a hidden incision. Patients who are on blood thinners are relative contraindications, as stopping bleeding with the endoscopic approach is more difficult than the open approach. Risks of the procedure are again low, but can include nerve and vessel injury.

Endoscopic forehead osteoma and lipoma removal is a relatively common procedure that plastic surgeons are well trained to perform.

Cost of forehead bump removal

The cost of removal is dependent on the complexity and size of the lump as well as the technique used. Open excisional techniques are typically more straightforward and require shorter operative times, and can address bumps of any size, but the trade-off is a potentially visible scar and the need for after procedure scar therapy. Endoscopic scarless forehead lump removal is a more complex procedure involving more instruments and technology, and is usually reserved for small to moderate sized bumps. However, done well, the post-operative recovery is fast and there are no visible scars. The costs of these procedures can range from $2000 upwards, with the need to factor in costs of operating theatre time, instruments as well as the possible need for an anaesthetist to administer anaesthesia.

If you have had that bump on your forehead for a while and are wondering whether it is treatable by a scarless approach, do seek advice from a board-certified plastic surgeon who can advise you accordingly.

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