Facial Lipoma and Cyst Removal

Lipoma is a benign fatty growth that can occur anywhere on the body. Cyst (sebaceous cyst, epidermal inclusion cyst, dermoid cyst, pilar cyst, infundibular cyst) is slow growing sack of skin tissue that can also occur anywhere on the body. Lipomas often grow slowly over time and can become painful as they push on surrounding tissues. Cysts can drain, rupture, grow larger or become infected. Dr. Taylor and Dr. Sullivan can safely and gently remove lipomas and cysts under local anesthesia to improve the appearance or symptoms. Incisions can often be hidden in a nearby wrinkle or tissue fold and removal of lipomas and cysts is usually straightforward. Patients recover quickly with little discomfort and dissolving sutures that are buried and do not require removal. For lesions on the scalp, unlike many other doctors, Dr. Taylor and Dr. Sullivan do not shave or remove hair.

Dermoid Cyst Removal

What is a dermoid cyst?

One of the most common congenital facial masses is the dermoid cyst.  These benign (not cancer) cysts occur along embryonic “fault lines”, as skin appendages become trapped beneath the skin surface during development.  Because of the nature of their development, they are usually seen in predictable locations: most commonly the lateral eyebrow (“angular dermoid”), the medial eyebrow, the nose, along the coronal skull suture, or behind the ear in the retro-auricular parietal scalp.  Dermoid cysts have a skin lining which secretes sebaceous material, and more rarely contains other ectodermal components such as teeth, hair, or nails.  They usually present as a firm mobile non-tender mass.

What is the differential diagnosis?

The differential diagnosis is location dependent.  For a midline nasal mass in infants, glioma, encephalocele and vascular anomalies represent the majority of other diagnoses.  For a mass in other locations, pilomatrixoma, epidermal inclusion cyst, and branchial cleft cyst may mimic a dermoid. In adults, lipoma, epidermal inclusion cyst, sebaceous cyst, infundibular cyst, and pilar cyst are other possible diagnoses.

For non-midline lesions without complicating factors, excision is both diagnostic and therapeutic.  For midline masses imaging is recommended to clarify the diagnosis, and to determine if there is intracranial extension.  CT scan, MRI or both may be required preoperatively depending on the lesion and surgeon preference.

What is the natural history?

Cysts may grow as material collects within.  They may rupture, get infected, create a bony defect in the skull or contour defect in the soft tissue, or in the worst case scenario facilitate intracranial infection or meningitis.  Rarely patients present with intracranial abscesses or meningitis and are only secondarily found to have a dermal sinus tract communicating with an intracranial cyst.

What is the treatment?

Surgical excision is recommended because of the risk of growth, infection, and rupture. The need for preoperative imaging depends on location and if there are other complicating factors. For extracranial small cysts excision can usually be carried out through a small incision as an outpatient operation. Dr. Taylor and Dr. Sullivan, top board certified plastic surgeons in the Boston Mass area, can carefully and safely remove the cyst. The incision can usually be hidden in a nearby wrinkle or crease, such as the eyelid. The procedure can be performed with little to no pain or discomfort by using numbing medicine. The incision is then meticulously closed with all dissolving stitches that are buried and do not require removal. Patients recover quickly and can usually shower that day and return to normal activities. Both adults and children tolerate the procedure quite well. Dr. Taylor and Dr. Sullivan are also comfortable caring for children and working on the face as they are not only plastic surgeons, they are both also fellowship trained in pediatric and craniomaxillofacial surgery.

DSC_0473.jpg

Sebaceous Cyst

Cysts form in the deep layers of the skin and subcutaneous tissue (fat layers) and slowly grow larger in size. Sometimes they connect with the overlying skin and appear as a "blackhead". They can also occasionally become infected. When cysts grow they can become physically deforming as well as compress surrounding structures such as bone, nerves and blood vessels. This cyst is approximately 2 cm in size and was easily and gently removed under local anesthetic. The patient felt no discomfort and the site was closed with dissolving stitches that were buried and do not require removal. When cysts are meticulously removed such as this lesion, the chance of growing back is extremely low and the recovery is straightforward.

DSC_0125.jpg

Osteoid Osteoma

Benign bone growth of the skull that can mimic a cyst, though originates from the bone rather than the soft tissue. Left untreated, they can continue to grow larger and invade the skull bones. This osteoma is approximately 1 cm in size and was easily and gently removed under sedation and local anesthesia. The small incision was placed in an overlying wrinkle. When they occur under the scalp, no hair is removed or shaved. The patient felt little to no discomfort and recovered without interruption in usual activities.

MINOR PROCEDURE POSTOPERATIVE INSTRUCTIONS

  • Use medication as directed. Most commonly, pain control will be from the local anesthetic, acetaminophen, ibuprofen, or naproxen. You may experience some soreness as the local anesthetic wears off.

  • Most wounds will be closed with absorbable sutures and Dermabond (skin glue). The skin glue forms a barrier to water. Over the skin glue you may have Steri-Strips (white or tan tape). Please do not remove the Steri-strips. Leave them in place until they fall off on their own. They may stay for a few weeks.

  • Unless otherwise instructed, you may shower the day of the procedure. Please avoid bathing or soaking the wound in water.

  • Observe the wound for signs of infection such as redness pus or fevers. Please call your surgeon if signs of infection are noted.

  • Please call the surgeon if you have any questions or concerns.

  • Elevate the surgical site when possible. For facial surgery, consider sleeping with extra pillows. Elevation will help decrease discomfort and minimize swelling.

  • It is important to be seen by Dr. Taylor or Dr. Sullivan after your operation. Call to schedule your appointments at Taylor & Sullivan Plastic Surgery office at (617) 492-0620 between the hours of 8:30 – 5:00 or visit our webpage at www.massplasticsurgeons.com.