Question 1

Scar-free, minimally - invasive treatment of forehead lesions

Accepted Answer

The endoscopic approach allows removal of forehead lesions without visible scarring, as the access incision is placed behind the hairline within the hair-bearing scalp. To the best of my knowledge, I first described the endoscopic removal of osteomas, lipomas, and other forehead lesions in 2001 and, to my knowledge, I perform the highest number of these procedures as a single surgeon.
Hair does not need to be cut or shaved. For patients without hair, I have also developed suitable alternative access techniques.

Question 2

How is endoscopic removal of forehead lesions performed?

Accepted Answer

I personally perform every procedure. Surgery is typically carried out on an outpatient basis under sedation. You will be positioned comfortably on your back. After induction of sedation, access is gained through the hair-bearing scalp.
Using minimally invasive endoscopic instruments, the lesion is visualized and carefully removed in a controlled manner.

Question 3

What are the advantages of the endoscopic approach?

Accepted Answer

The primary advantage is the avoidance of a visible scar in the forehead region. In addition, access is gained from the base of the lesion, which—based on my experience—allows for more controlled removal of both lipomas and osteomas. Paradoxically, exposure of the lesion is wider and more targeted endoscopically than through an open incision.
The procedure is minimally invasive, performed on an outpatient basis, and in most cases patients can return home the same day.

Question 4

Which type of anesthesia is appropriate?

Accepted Answer

Most of my patients choose sedation. However, removal under local anesthesia or general anesthesia is also possible, depending on individual preference and clinical considerations.

Question 5

Is a scar-free approach possible in patients with hair loss?

Accepted Answer

Yes. In men with reduced hair density, access can be achieved, for example, through two micro-incisions of approximately 10 mm each or via an upper eyelid incision. In nearly all cases, I have a technique available that minimizes or avoids visible scarring as much as possible.

Question 6

Can a tissue sample be taken?

Accepted Answer

In most cases, the removed tissue can be sent for histological examination. Only in very small, flat osteomas may it be impossible to obtain a specimen; in these cases, the lesion is gently contoured by tangential burring.

Question 7

Is there a risk that the lesion is malignant?

Accepted Answer

The vast majority of these lesions are benign lipomas or osteomas. In my experience of several hundred cases, I have encountered only one malignant lesion, which occurred in a patient with a known prior tumor history.

Question 8

What is the risk of recurrence?

Accepted Answer

Based on many years of experience and a high procedural volume, lipomas I have treated as primary procedures have not recurred. Recurrence of lipomas may occur if they were previously removed via an external skin incision and the capsule was disrupted.
Osteomas, interestingly, do not tend to recur, even though complete removal is not expected; typically, only the protruding portion is tangentially removed. In some cases—particularly with broad-based osteomas—perfect contouring can be technically challenging, and minor surface irregularities (e.g., visible under certain light reflections) may remain. Secondary contouring procedures are infrequently required.

Question 9

Do sutures need to be removed?

Accepted Answer

The access incision is usually closed with skin staples, as these are gentler on hair follicles than sutures. Many of my patients travel from afar; staples can be removed locally by a physician after approximately 10 days. I am grateful for this collegial support.

Question 10

What should be considered after endoscopic removal?

Accepted Answer

The procedure is performed on an outpatient basis. You will be discharged with a forehead dressing, which you can remove yourself after one or two nights, according to instructions. Showering and hair washing are then permitted.
Some patients experience swelling or bruising, while others do not. Depending on individual healing, many patients are socially and professionally fit again by day three, while others may require up to one week.

Question 11

Before-and-after photos

Accepted Answer

Treatment results can be viewed in the “Before and After Photos” section.

Question 12

Cost and preliminary inquiry

Accepted Answer

If you send us photographs of your forehead lesion, I will be happy to provide a non-binding preliminary assessment of the procedure and estimated costs.
Please send the photos to praxisteam.gassner (at) gmail.com and include your name, gender, date of birth, address, and treatment request.
I will respond personally. By submitting your data electronically, you consent to electronic communication and acknowledge that data transmission in both directions occurs at your own risk.

Question 13

Expertise

Accepted Answer

The only fully U.S.-trained Facial Plastic Surgeon (ABCFPRS) currently practicing in Europe
Eight years of training at the Mayo Clinic, USA
Subspecialty fellowship in Facial Plastic Surgery (AAFPRS, 12 months), University of Washington, Seattle
Ten years as Head of the Section of Plastic and Reconstructive Head and Neck Surgery, University ENT Department Regensburg
First author and originator of the endoscopic technique for removal of forehead lesions
To my knowledge, the highest procedural volume worldwide for a single surgeon in endoscopic removal of forehead osteomas and lipomas

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Treatments / Endoscopic Removal of Forehead Osteomas and Lipomas

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Endoscopic Removal of Forehead Osteomas and Lipomas

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