Osteoma Treatment: A Step-By-Step Guide to In-Office Surgery

What is an Osteoma?

An osteoma is a bone growth that is usually benign and painless, and typically appears as a raised, firm bump on one’s forehead or scalp.  Even though osteomas rarely have associated symptoms or pain, the appearance of an osteoma–particularly on the face–can be bothersome for many patients. Our facial plastic surgeon Dr. Fishman commonly removes osteomas in the office. While osteoma surgery is a relatively straightforward procedure, it can still be nerve-wracking and anxiety-producing for many patients. Read on to learn the step-by-step the process and what can be expected for your osteoma treatment. 

Osteoma Removal

Treatment starts with a consultation with Dr. Inessa Fishman, who is a facial plastic surgeon trained in Ear, Nose, and Throat surgery. During this visit, Dr. Fishman examines your facial and head anatomy, reviews your medical history, and discusses treatment options with you, carefully and thoroughly going over risks and pre- and post-treatment instructions. If she suspects an osteoma based on her physical exam, she typically recommends CT (or “CAT” scan) imaging prior to surgery planning. This scan allows her to gain a better understanding of your bump’s location and extent, and the surrounding bony anatomy, both of which are both important for safe treatment.  The staff at Aviva assists you in finding an imaging center near you, whether located in Atlanta or elsewhere, in order to get this scan study.

After the scan is completed, Dr. Fishman reviews it to decide whether surgery is appropriate for your osteoma or bump treatment.  After review of your imaging, typically surgery can be scheduled. At Aviva Plastic Surgery, osteomas are most commonly treated in our office and do not require general anesthesia; in fact, we most commonly use by-mouth relaxing medications and laughing gas to help our patients feel their most comfortable, awake, and relaxed during osteoma treatment. This in-office procedure reduces treatment cost and allows for a quicker recovery.  

It is important to stop all non-prescription blood thinning medications and supplements prior to surgery. This prevents excessive bleeding during treatment, and reduces the risk of bruising and hematoma (or blood collection under the skin) following treatment.  The list of blood-thinning medications to avoid ca be found here. As alcohol is a blood thinner as well, we recommend avoiding its use for 48 hours before and after surgery.  

On the day of your osteoma removal, we ask that you arrive at the office in a button-up shirt with clean, dry hair that is free of hair styling and products.  Because we do not use general anesthesia, there is no need to fast before treatment.  We ask patients to arrive at the office about one hour prior to scheduled start time, in order to review any questions about treatment and take relaxing medications. 

Relaxing medications take about 15-45 minutes to 1 hour to take full effect; we give these and relaxing laughing gas to help patients get relaxed before injections of numbing medicine or incisions. Depending on their tolerance, relaxing medications allow many patients to doze off during the procedure, or be awake and feel very relaxed. It is important to note that after taking relaxing medication, Dr. Fishman recommends against driving for 24 hours or until the relaxing medications wear off. As such, you must have a responsible, trusted adult to take you home after your procedure. 

Once you are feeling relaxed, Dr. Fishman injects a local anesthetic (or numbing or freezing medicine) to take away any pain or discomfort of the procedure. These injections do sting for 1-2 minutes, but with the help of relaxing medications, patients tolerate the injections well. Once the numbing medication has taken effect, Dr. Fishman begins your treatment. 

For the majority of osteoma removals, Dr. Fishman makes a small incision just behind the hairline, allowing any scarring to be concealed. She then dissects under the forehead soft tissues to access the bony growth, using her expertise to ensure no fragments are left behind and the treated forehead has a smooth, natural-appearing curvature. A sample of the tissue removed is sent for testing to ensure the growth is benign.  Dr. Fishman then sews up the scalp incision using very small and inconspicuous stitches. 

Following treatment, Dr. Fishman applies a compressive gauze headwrap to reduce swelling. We take off this headwrap at your first post-operative appointment, 1 day after surgery. Dr. Fishman recommends a regimen of Tylenol and Motrin for 1-2 days following treatment to reduce soreness and discomfort. Applying cool compresses to the area of treatment can also help with swelling and pain. Itching, tightness, and some patchy numbness are normal for several days to weeks after your treatment; these resolve gradually, and sensation returns to normal within 6-8 weeks post-surgery.

Dr. Fishman removes your stitches at 1 week after surgery, in order to minimize scarring. Beyond the first week visit, Dr. Fishman prefers to see you in the office for follow-up visits every 4-6 weeks for approximately 3-4 months to ensure smooth healing. For patients located outside of Atlanta, these visits can be completed virtually. 

Read more about osteoma treatment at our practice here.  Our staff is happy to answer any other questions you may have; feel free to call us at (678)-974-8435.