Lipomas, osteomas, and various other “bumps” on the scalp, face, and neck are common concerns among patients who come to our practice. A lipoma is a benign (non-cancerous) fatty growth which may appear on various parts of the body, face and scalp. The most common soft tissue tumor, a lipoma is a slow-growing collection of fat cells enclosed in a thin, fibrous capsule or covering. A lipoma usually feels like a soft of doughy lump which can be moved around under the skin.
Lipomas occur in 1% of the population, and are most often asymptomatic and painless. In the head and neck, lipomas may develop in areas that are usually devoid of fat (such as under the brow-lifting forehead muscles) or within the fatty pads which normally comprise the cheeks. Lipomas may cause no symptoms, or result in mild discomfort; most patients are bothered by their unsightly appearance. While no one knows why lipomas develop, the leading scientific theories highlight genetics and trauma as possible causes.
Facial Plastic surgeon Dr. Inessa Fishman treats a variety of head and neck masses, including lipomas. Whether a lipoma causes discomfort or an aesthetic concern, an excisional surgery to remove it often proves diagnostic and therapeutic for our patients.
Our Facial Plastic surgeon, Dr. Inessa Fishman, most commonly removes lipomas via a minor surgical procedure, performing lipoma excision surgery with local or general anesthesia. The size and location of the lipoma help design a specific treatment plan; this said, the vast majority of the lipomas Dr. Fishman removes are treated with the help of local anesthesia and relaxing medications in the comfort of our clinic.
During surgery, and after freezing the area of treatment with numbing medicine, Dr. Fishman places an incision directly on top of the lipoma or behind the hairline, for lipomas within the forehead or scalp. She dissects and removes the lipoma and carefully closes the surgical incision for the best cosmetic result. The scar after lipoma removal surgery tends to heal quite well over time; most scars are hidden within the hair-bearing scalp or the natural expression lines of the face.
Any mass or “knot” that develops on the scalp, face, or neck should be carefully examined by one’s physician. Because lipomas are common and have a classically soft feel, they are commonly diagnosed on physical exam; occasionally, patients may undergo imaging (such as a CT scan or ultrasound) or biopsy to diagnose a lipoma.
Surgically removing or excising a bump can be both curative and diagnostic, in that the tissue removed undergoes pathology analysis to yield the diagnosis of lipoma, or something else. Men and women who are in good health and bothered by the appearance of a mass or bump within the head and neck may be good candidates for lipoma treatment, including excision surgery.
Most patients seeking treatment of a forehead or facial growth do not have symptoms or pain; in fact, most patients are bothered by the appearance of a growth or lump or forehead knot, and have grown tired of answering other’s questions about it.
The patient shown here is a 43-year-old woman who was bothered by the appearance of a slowly growing bump on her forehead. Dr. Fishman removed this growth, which turned out to be a lipoma, with a short office-based surgery, and the patient is shown with great healing, an excellent outcome, and an essentially invisible scar hidden by her hair. The patient reports feeling more self-confident, and no longer worries about trying to hide or camouflage her forehead bump with her hair.
Most head and neck lipomas at our practice are removed with the help of laughing gas (ProNox) and injectable numbing or freezing medicine. General anesthesia or sedation may work well for patients with very large, deep, or recurrent lipomas. With this said, Dr. Fishman discusses her anesthesia preferences during your consultation and as part of your individualized treatment plan.
Because of its classically soft and mobile feel, the diagnosis of a lipoma is often established with the help of a physical exam and confirmed with pathology analysis of the tissue removed during excision surgery. However, occasionally, a bump presents with less than clear-cut characteristics; this presentation or a particularly sensitive location may prompt imaging (such as a CT scan or ultrasound) for better evaluation of the tissue in question. Dr. Fishman will discuss her preference for imaging with you during your consultation.
Dr. Fishman typically removes most head and neck lipomas in 45 minutes to 1.5 hours, depending on the amount of work to be done and other associated procedures. Most patients undergoing lipoma excision with local anesthesia can expect to be in the office 1-2 hours. This time includes going over pre-treatment questions, reviewing the consent forms for treatment, taking pre-treatment photographs, receiving the laughing gas and freezing/ numbing medicine, undergoing the excision procedure, and recovering.
Any surgery that involves cutting through the skin leaves scars, and we take pride in providing effective treatment with essentially inconspicuous scars. While lipoma surgery leaves scars, these are hidden in the hair-bearing scalp or the natural forehead creases or facial expression lines. These scars fade significantly over time and are difficult to find once healed.
Most of Dr. Fishman’s lipoma treatment patients describe bruising or soreness after surgery, with most discomfort fading away within 1-2 days after treatment. Most people will have mild to moderate discomfoty, which can be well-managed with cool compresses and oral pain medications (such as Tylenol and Motrin). Some patients may develop mild bruising after surgery, which usually resolves over 3-5+ days. Temporary numbness and itching about the treated area are quite common and resolve over the course of a few days to weeks in the vast majority of patients.
The risks of lipoma removal surgery are small, but still significant. The most common risk or complication of removing a lipoma (or any other bump) includes bleeding and bruising, with most bruising resolving over the better part of a week. A fluid collection under the skin (such as a hematoma or seroma) may develop. Infection poses a small risk, with the rich blood supply of the head and neck making infections uncommon. Other risks include numbness, hair thinning, unsatisfactory scarring, or recurrence of the lipoma or bump.
Dr. Fishman and her staff send the removed tissue for pathologic analysis to a certified and highly experienced pathology laboratory. Pathologic analysis provides a more precise diagnosis than a physical exam and radiologic imaging, and can differentiate between lipomas, osteomas, cysts, cancer growths, and other reasons for “bumps.”
Health insurance plans may cover the removal of lipomas that cause pain or other functional symptoms. Health insurance plans do not typically cover the removal of lipomas for appearance-related or cosmetic reasons. We recommend checking with your insurance provider regarding the details of your healthcare plan. We do not contract with insurance companies at our practice; we do offer financing options to help cover the cost of treatment, and are happy to discuss this with you after your consultation with Dr. Fishman.
An approximate cost for lipoma removal surgery in our practice is $4,000-5,000. Costs vary based on individual patient needs and other procedures being performed concurrently. For your individualized treatment plan and pricing information, please contact us to schedule your consultation. For financing options, learn more about our financing resources.
Immediately after treatment, you will likely notice some swelling, numbness, bruising, and paleness about the treated area.
The numbing medicine wears off 4-6 hours after treatment. Post-treatment, you may have mild-moderate soreness or discomfort, which should be controlled with by-mouth medications like Tylenol and Motrin.
While swelling is common and normal after lipoma excision surgery, cool compresses can help minimize swelling and discomfort and should be used on the treated area as instructed.
You should be able to bathe, shower, and wet your incision approximately 24 hours after treatment.
Stitches are usually removed at 7-10 days after surgery.
Depending on your health, medical history, and recovery, you should expect to be presentable (and return to work and social activities) in 5-7 days after treatment.
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