Objective: The traditional approach to access a forehead mass is a hemi- or bi-coronal incision. A forehead flap is then raised to allow for adequate visualization and resection of the lesion. More recently, the endoscopic approach has been used for aesthetic forehead procedures and browlifts, as well as for reconstruction of bony and soft tissue defects of the forehead. The objective of this report is to describe the sub-periosteal endoscopic approach for resection of benign masses of the forehead and glabella. This technique minimizes post-operative scar formation, provides improved cosmetic outcomes over traditional approaches, decreases pain scores, reduces wound-associated complications, and shortens duration of inpatient stay.

Methods: A retrospective analysis with photographic documentation of four patients who underwent endoscopic resection of forehead masses over a 3 year period was performed.

Results: The patients, ages 7, 16, 19 and 25 years underwent resection of benign forehead masses using the endoscopic appraoch. There were no wound infections. Post-operative pain was reported as minimal by all patients. Three procedures were performed on an outpatient basis and one patient (the 7-year old) was kept as an inpatient for 2 days. Subsequent follow up revealed well-healed port placement sites without scarring.

Conclusions: The endoscopic sub-periosteal approach for ablation of benign forehead masses has many merits over the traditional hemi- or bi-coronal approach. Photodocumentation will be provided that demonstrates improved cosmetic outcome. The endoscopic approach decreases post-operative pain and potential for wound infections as well as reduces inpatient hospital days. In addition, this approach is desirable for patients with a personal or family history of hypertrophic scarring or keloid formation.
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