Subgaleal Lipoma directly above mid eyebrow - how risky would it be to have it removed? (Photos)

Hello, and thank you for your thorough question. Your concerns are completely valid and well thought out.

A subgaleal lipoma in the mid-brow region, especially of the size and depth you described (20 x 18 x 4 mm), does require special care given its proximity to critical neurovascular structures and its visibility in a highly cosmetic area. It's very appropriate that you’ve been referred to a board-certified plastic surgeon, as experience and precision are key here.

Here are a few important points to consider:
1. Risk Level and Safety
The procedure is generally safe when performed by a skilled facial or plastic surgeon. However, due to the location, some specific risks include:

Injury to the supraorbital nerve or other small sensory nerves, which could lead to numbness or tingling in the forehead

Bleeding or bruising due to nearby arteries

Subtle changes in brow contour or asymmetry occur if the muscles or fat pads are disrupted

These risks can be minimized with proper preoperative planning and surgical technique.

2. Incision Size & Placement
Incisions are typically kept small (1.5–2.5 cm) and may be:

Directly over the lesion, often hidden within a natural crease or brow line

In select cases, placed behind the hairline with an approach under the skin to limit visible scarring (though this may be less practical for smaller lipomas)

A cosmetic-conscious surgeon will work to align the incision with natural facial anatomy for best healing.

3. Risk of Eyebrow Elevation or Facial Asymmetry
There is a low risk of temporary or permanent eyebrow elevation or asymmetry, especially if the frontalis muscle or supporting tissues are affected. To minimize this:

Choose a surgeon with extensive experience in facial anatomy

Clearly communicate your concerns about maintaining facial balance and aesthetics

4. Choosing the Right Surgeon
When looking for a surgeon, I recommend:

Confirming board certification in plastic or facial plastic surgery

Reviewing before-and-after photos of similar procedures (even if shown only in-office)

Asking how often they perform lipoma excisions in cosmetic regions

Ensuring they discuss both functional and cosmetic outcomes with you

You’re absolutely right to advocate for yourself, and seeking clarity before a procedure is a sign of a well-informed patient. With the right surgical hands, removal can be done safely and with excellent cosmetic results.

Warm regards,
Dr. Anna Chacon

Low risk if you have a plastic surgeon do it. These are usually removed through a small transverse (horizontal) wrinkle fold incision right above the brow. The supraorbital nerve exits the skull right at the orbital rim, either directly or through a notch, and courses under the medial aspect of your lipoma between 2 and 5 o'clock. The incision is made through skin only, then with a blunt spreading technique in line with the nerve, the capsule of the lipoma is found, isolated by blunt dissection, and the lipoma is removed, while the nerve has been pushed to the side. So yes, some risk, but in experienced hands, acceptable. The scar would be maybe 3/4 to 1". If it is too small, too hard to do the operation.
Interesting how when you take a picture in a mirror, one would think it is over your right brow.
The facial nerve branches to the frontalis are a bit higher, and likewise, with this technique they would also be pushed out of the way. No nerves run through the lipoma.
Board-certified plastic surgeons do this all the time, so you should not have any difficulty in finding one.

It is easy to remove if you have experience. I have done a lot of these. The biggest risk is permanent numbness above the incision line extending into the forehead. That is however rare and I have never seen it. You have to be very careful as a surgeon as the supraorbital nerve is right underneath your lipoma location.
Regards
Dr. Janjua

There are no significant arteries or nerves directly in this area. There is the suborbital branch but that can be easily preserved. You can use a direct approach with an incision right over the lipoma. Another approach would be an incision at the eyebrow level or within the eyebrow itself. The last approach would be a incision at the hairline. Basically, like a brow lift and dissecting out from below. All 3 approaches have pros and cons.

Best Wishes,

Gary Horndeski, M.D.