Forehead soft tissue nodule not lipoma? (Photo)

Without a physical exam it is difficult to give you a good answer. That being said, lipomas have very typical characteristics on CT scan and if the surgeon reviewed the scan I bet he got it right.

They can be hard to find. With your history of trauma scar tissue is also a real possibility.

Also a simple epidermal cyst is probably the most common lesion in this location. 

It is difficult to appreciate in the photo but it if does not bother you cosmetically watchful waiting is another option as the CT scan and surgeon analysis both suggested a benign process.

Hope this helps.

Best of luck,



DrC

In this case, I would get an MRI to confirm the presence or not of a lipoma. Their signature on MRI is pretty diagnostic.  Once confirmed, re-operation would be reasonable.  You might then have your original or another board-certified plastic surgeon re-operate. For reasons other surgeons have listed, the lipoma might have been missed during the first operation.

Sorry you are having this problem. Quite correctly, your physician sent you for a CT evaluation prior to any surgical intervention. CTs and ultrasounds are typically pretty good in making sure that the lump does not relate to underlying bone or nerve problems. If scar tissue is playing a role in the bump, the injection of an anti-inflammatory agent may help to shrink it and make it much less visible, used either alone or in combination with a small amount of hyaluronidase. If a deeply located lipoma is the culprit, Kybella, rather than repeat surgery, may be considered to inject it and shrink it (although this is a completely off-label use of this product, which is approved for treating submental--double chin--fat deposits). At this point, you might consider seeking a second opinion. Best of luck. 

Thank you for sharing your question and photograph and I am sorry to hear of your soft tissue mass that has persisted for 10 years.  In most instances a CT scan or ultrasound should provide the appropriate diagnosis as the tissues are thin enough to allow excellent resolution. Though nothing replaces an in-person examination I would seek a second opinion as a lipoma looks likely.  Hope this helps.

Sometimes lipomas on the forehead can be below the muscle.  I am not certain if your surgeon went that deep to look for a lipoma or not.  Was anything removed at the time of your surgery?  It is possible it could be scar tissue, but normally this could be removed as well.  

The swelling on your forehead could be a sub muscular lipoma.  If you contract the muscles on your forehead to lift your brows a sub muscular lipoma will become harder to feel.  Best wishes

Hi there and thank you for your question.

The history you describe is typical for a lipoma, that is to say a soft tissue nodule (and technically a lipoma is such a nodule) without bony involvement. As the bone is not involved then the swelling cannot be from that so must be in the soft tissue and this looks very evident in the photograph; of course nothing replaces direct face to face examination or indeed intra operative examination. Some types of lipoma can be interwoven with the normal tissues of the forehead, in such cases it is more difficult to remove the nodule. If the surgeon is using local anaeshetic, then the swelling from the injection of local anaesthetic can 'blur' the margins and make it more difficult to distinguish the swelling of the local anaesthetic from margins of the lipoma or the nodule causing the swelling. Finally some are 'angiolipomas' which are vascular and once the wound is created excess bleeding can also make it difficult to see and remove the mass easily; there are sensory nerves going up in this region which if damaged can cause sensitivity or pins and needles after treatment and this can naturally (and rightly) deter the surgeon in being more aggressive in the surgery.

Taking the above into account, although your problem is usually easily dealt with, it can on occasion me more awkward; it will therefore be important to discuss whether the risks of surgery outweigh the advantages of removing the lump; the risks then are also dependent on the experience of the surgeon and in your case I would seek the advice of a very experienced surgeon who is happy to discuss the issues with honestly and openly.

I hope that this information was helpful.

My very best wishes in finding a successful outcome!