*Actual Patient of Dr. Shah
Before and After
Endoscopic forehead osteoma removal is done on an outpatient basis. Due to Dr. Shah’s technique of selectively blocking nerves with local anesthesia, most patients only need minimal anesthetic, allowing for a relatively pain free experience. Many patients are able to return to work either the next day or in a few days.
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Ways of Removing Forehead Osteoma
The classic approach to the removal of forehead osteomas is using an incision along the face. Dr. Shah’s preference is to recontour the bone of the forehead with the use of an endoscope. By making the incision in the scalp, no scar is visible on the face, making scarring virtually invisible. The instruments Dr. Shah uses to reshape the forehead create an improved appearance and smoother to the touch.
CORONAL APPROACH
Traditionally speaking, the removal of osteomas utilizes a coronal scar. As you can see in Figure A., the path of incision is just behind the hairline. There are two main issues with a coronal scar. First of all, the scar can be seen rather easily in some patients and with some hairstyles, particularly shorter hair.In addition, there is a nerve from the patient called the supraorbital nerve which will be cut when performing a coronal incision. This nerve provides sensation to the scalp which can be disconcerting to the patient as they cannot feel their hair when brushing it or combing it.
DIRECT APPROACH
The other approach to removing osteomas has involved direct incision of the lesion over the skin (Figure B.). This can create a visible scar in the forehead and can result in a trade off of removal of the osteoma with a visible scar.
DR. SHAH’S APPROACH
Dr. Shah has pioneered a technique to remove the lesions by concealing the scar in the scalp. By hiding the small incision within the scalp (as highlighted in Figure C.), the patient can have an incision which is difficult to see.
While it is technically more difficult to remove the osteoma from this approach, it does allow for a more pleasing aesthetic outcome. Dr. Shah has perfected this procedure and his removal process uses a minimal evasive path of dissection (as represented by the yellow cone in Figure D.) that allows for limited visible swelling and cuts down on the recovery time that a patient would have with a coronal or direct incision. Patients are ready to go back to their daily lives in no time at all.
OSTEOMA REMOVAL CASE STUDY AND TESTIMONIAL
One of the greatest parts of being a facial plastic surgeon is that there are a number of ways of performing one procedure. I think anyone who does things “by the book” loses out on the creative element necessary to be a successful plastic surgeon.
*Actual Patient – Before Removal by Dr. Shah (left) and After Removal (right)
For example, this patient had a forehead osteoma, which is a hard lump on her forehead. (See photographs with blue outline). She has a history of keloids, or forming large thick scars. Rather than place a large scar on her forehead, I used an endoscope (an instrument the size of a drinking straw) and specially designed narrow instruments.From a small incision, I was able to contour the forehead so that she did not have a large bump on it and continue to wear her hair short and with confidence, avoiding a visible scar and any disruption of her hairline.
DAN’S OSTEOMA STORY
Dan is a patient of Dr. Shah’s who received this forehead bump procedure to remove his osteoma. This is his journey to help better understand what to expect from this procedure.
Frequently Asked Questions
Are all bumps on the foreheads osteomas or lipomas?
No, there are a variety of medical conditions and normal anatomic variations which can mimic either.
Do I always need a CT scan?
Not necessarily. When the diagnosis is highly certain, imaging may not be necessary. Typically, lipomas do not need CT scans.
How can you tell a lipoma from an osteoma?
Since osteomas are fixed to the bone, there is no movement. Lipomas will move (sometimes fairly subtle).
Is the removal painful?
Typically it is fairly pain free experience often equated to a dental procedure.
Do I need anesthesia?
Most patients are able to do the procedure comfortably in the office. Patients always have the option to have the procedure performed under general anesthesia or in OR setting especially if they have difficulty “numbing” with local anesthesia.
Can I see the osteoma or lipoma when it is removed?
Yes, patients often want to see the osteoma or lipoma.
What is the number one reason why patients have forehead bumps removed?
Often times it is because patients notice that when they are conversing with others that their eyes are focused on the bump rather than making eye contact. Other patients notice that they are forced to wear bangs.
Do bumps grow back?
If the bump is an osteoma or lipoma there is always a chance for recurrence. Dr. Shah’s recurrence rate is less than 1%.
Will I have a bruise?
Depends on location of forehead bump and whether or not you have a tendency to bruise easily. Most patients do not bruise when the osteoma is located near the hairline while osteomas near the brow area have a higher incidence of bruising.
Will I have numbness afterwards?
Typically our patients do not experience numbness. This is in part due to the design of Dr. Shah’s incision (parallel to the sensory nerves) as well as his anatomic dissection plane.