Osteomas, lipomas, cysts, and various other “bumps” on the scalp, face, and neck are common concerns among patients who come to our practice. An osteoma is a benign (not cancerous) bony growth which can appear as a hard, fixed knot or bump on the forehead or scalp, though osteomas can sometimes develop within the sinuses as well. An osteoma of the forehead or scalp typically feels like a raised, solid bump which is firmly affixed to the underlying bone. While one can move or slide the skin and tissue over the bump, the osteoma itself cannot be moved or shifted. Osteomas usually develop slowly over time, and most commonly present in a person’s 20-40s. While they are most frequently solitary, it is not unusual for a patient to present with multiple osteomas. Usually asymptomatic (or not causing symptoms), osteomas rarely cause pain or discomfort and most commonly bother people by their appearance. Osteomas do not typically get infected, drain, or contribute to skin changes within the overlying skin. While no one cause has been definitely identified for the development of osteomas, the most commonly accepted scientific theories point to genetics and trauma as possible causes.
Our facial plastic surgeon Dr. Inessa Fishman most commonly treats osteomas via a minor surgical procedure; she performs osteoma surgery in the office (with local numbing medicine) or in the operating room with the help of general anesthesia. The size and location of the osteoma or osteomas help Dr. Fishman design a specific treatment plan; most commonly, Dr. Fishman removes osteomas with the help of local anesthesia (injected numbing medicine) and relaxing laughing gas (called ProNox), in the comforting environment of our clinic.
After freezing the area of treatment with numbing medicine, Dr. Fishman places an incision directly above the osteoma or behind the hairline for osteomas within the forehead or scalp. She dissects and “shaves down” the bony bump of the osteoma, then carefully closing the surgical incision for the best cosmetic outcome. The scar after osteoma surgery usually heals very well over time; while the incision never completely disappears, it can be difficult to find when well-healed. Most scars are hidden within the hair-bearing scalp or the natural expression lines of the face, allowing for excellent scar camouflage.
Any mass or “knot” that develops on the scalp, face, or neck should be carefully examined by one’s physician. Because osteomas are relatively common and have a classically firm and fixed feel, they are typically diagnosed on physical exam; occasionally, patients may undergo imaging (such as a CT or “CAT” scan) or biopsy to diagnose an osteoma. Dr. Fishman usually discusses her imaging preferences for suspected osteomas with patients as part of her consultation. 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 osteoma, or something else. Men and women in good health and bothered by the appearance of a mass or bump within the head and neck may be good candidates for osteoma treatment, including excision surgery. If you are bothered by a bump at your face or scalp, consult with Dr. Fishman about your treatment options.
Most head and neck osteomas at Aviva Plastic Surgery are treated with the help of relaxing laughing gas (called ProNox) and injectable numbing or freezing medicine, though Dr. Fishman will discuss her anesthesia preferences during your consult. Overall, she uses local anesthesia, deep sedation, or general anesthesia for forehead and scalp osteoma surgery, deciding on the best approach after a thorough consultation and analysis of the bump’s location.
Dr. Fishman usually treats most face and scalp osteomas over 1 to 1.5 hours, depending on the amount of work to be done and other associated procedures. Most patients undergoing treatment of an osteoma with local anesthesia can expect to be in the office for 1.5-2 hours; this time includes discussing any pre-treatment questions, reviewing the consent forms for treatment, taking pre-treatment photographs, receiving the ProNox laughing gas and freezing medicine, undergoing the osteoma 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 osteoma surgery leaves scars, these are usually thoroughly 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. Dr. Fishman takes pride both in designing small, inconspicuous scars and ensuring their best healing over time.
Most of Dr. Fishman’s osteoma treatment patients describe a bruised or sore sensation, or a headache, after surgery, with most discomfort fading away within 1-2 days after treatment. Most people will have mild-moderate discomfort (like a dull ache) which is 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 very common, and resolve over the course of several weeks to months in the vast majority of patients.
Dr. Fishman and her staff send the tissue removed during osteoma treatment for pathologic analysis, using one of several certified and highly experienced Pathology laboratories in the Atlanta area. Pathologic analysis provides a more certain diagnosis than a physical exam and radiologic imaging, and can differentiate between osteomas, lipomas, cysts, and more rare reasons for “bumps.”
Health insurance plans may cover the removal of osteomas causing pain or other functional symptoms, such as sinus problems. Health insurance plans do not typically cover the removal of osteomas for appearance concerns or cosmetic reasons. It is best to check with your insurance provider regarding the details of your healthcare plan. Our practice is out of network with all insurance plans. We offer financing options and are happy to discuss this with you after your consult with Dr. Fishman.
An approximate cost for osteoma removal surgery in our practice is $4,000-5,000 when performed in the office; if performed in the operating room (such as may be the case with very large osteomas or those located in anatomically sensitive areas), cost ranges around $6,000-7,000+. 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.
Most of the time, yes. Dr. Fishman usually evaluates possible osteomas with a non-contrasted head head CT scan (also known as a CAT scan). This imaging allows Dr. Fishman to look at your bony anatomy and make sure she can design a safe and effective treatment plan. If you have had any kind of imaging for your forehead bump in the past, whether an ultrasound, X-ray, MRI, or CT scan, please provide this for our Doctor’s review on a CD.
If Dr. Fishman suspects your forehead bump is not an osteoma, she usually does not recommend imaging, or may perform her own ultrasound as part of your consultation. Dr. Fishman relies on her physical exam as an important part her consultation to help her determine whether imaging is needed. Because this is more challenging for our out of state or country patients, Dr. Fishman frequently orders imaging as part of her virtual consultations.
The goals of osteoma surgery include treatment of the bump and as little scarring as possible. Most forehead osteomas can be treated via an incision hidden within the hair or a natural forehead wrinkle, which is the same approached Facial Plastic Surgeon Dr. Inessa Fishman commonly uses for brow lifting surgery.
The patient shown is a 47-year-old man who was bothered by a slowly growing bump on his right forehead. Dr. Fishman treated him with surgical excision of what turned out to be a bony growth, or osteoma, arising just below the right forehead’s hairline. He has healed well 6 months after surgery, which was done in the comfort of our clinic, with the patient awake and relaxed with laughing gas. His scar is hidden within his hair for best scar camouflage.
Immediately after treatment, you will likely notice some swelling, numbness, bruising, and paleness about the treated area.
The numbing medicine wears off over a few hours after treatment; post-treatment, you may have some discomfort, which should be controlled with cool compresses and oral pain medications like Tylenol and Motrin.
While swelling is common and normal after osteoma surgery, cool compresses can help minimize both swelling and discomfort, and should be used on the treated area as instructed.
You may have a compressive headwrap dressing placed after surgery; when placing this dressing, Dr. Fishman generally recommends removing it after ~24 hours.
You should be able to bathe and shower—and wet your incision—approximately 24 hours after treatment.
Stitches are usually removed at 7-10 days after surgery. Out-of-town patients usually receive absorbable sutures which do not require removal.
Depending on your health, medical history, and recovery, you should expect to be presentable (and return to work and social activities) in a few days to 1 week after treatment
Take Tylenol 500mg by mouth every 4 hours for the first 48 hours after your procedure; this helps to decrease soreness, discomfort, and swelling.
Take Motrin 400mg by mouth every 6 hours for the first 48 hours after your procedure; this helps to decrease soreness, discomfort, and swelling.
You may apply cool compresses to your forehead or area of treatment every 1 hour as needed for discomfort. Do not use ice directly on the skin; instead use a gel pack or clean washcloth wrung out in ice water. The cool compresses should be applied after the head wrap is removed (as cold does not penetrate effectively through the head wrap).
Sleep with your head elevated above the level of your heart for 3-4 days; this helps to promote faster resolution of swelling. A recliner-type position or sleeping on a wedge pillow may be helpful for head elevation.
If Dr. Fishman has placed a tape dressing onto your incision and stitches, do not remove this until your follow-up appointment or as otherwise instructed. In general, incisions in or close to the hair-bearing scalp are left without tape dressing.
If you received a compression dressing or a head wrap, please remove this ~24 hours after your treatment unless instructed otherwise. You may get in the shower and wash your face and hair ~24 hours after treatment. You may allow water, shampoo, and facial cleanser to run over your incision and/ or dressing; pat dry the incision and/ or dressing after showering.
Avoid lotions, moisturizers, and creams on the incision and/ or tape dressing until you return to see Dr. Fishman.
Know that itching, tightness, and some patchy numbness are normal for several days to weeks after your treatment.
Return for your follow-up appointment in 6-7 days after treatment; you should expect to have stitches removed and for Dr. Fishman to examine you at that time.
Please call our practice with any questions or concerns. Please notify us should you develop a fever greater than 101.5 degrees Fahrenheit, spreading rash or redness, sudden swelling, bleeding, increasing pain, or any other concerns.
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