Lumps and bumps of the face are common. They are usually located in the subcutaneous layer right beneath the skin and, in some types, are directly attached to the underside of the skin. The most common pathologies are sebaceous cyst, dermoid cyst and lipoma. While they are benign they will usually continue to grow. While initially felt as a small non-visible lump, they often create an external distortion as they grow.
Facial cysts are mostly a cosmetic concern provided they do not get infected. (dermoid cysts and sebaceous cysts can, lipomas will not) While they can be quite disconcerting when they are found and they often continue to grow slowly, they can be removed in most cases with minimal scarring if done properly. Unsightly scars can make the facial area look worse in appearance than the original pathology.
While placing the incision in a skin crease away from the facial lesion site has the advantages of a more hidden scar, this is not always possible to do. The commonly used method is with a small skin incision directly over the lump. This also has the advantage in dermoid cysts that the attached skin pore is also completely removed to avoid cyst recurrence. In most cases the incision will need to be almost as long as the mass to ensure that its walls and contents are completely removed. These can be done under local anesthesia in the office in teens and adults. Infants and children will require an anesthetic to perform it.
As long as the incision is placed parallel to the relaxed skin tension lines of the face, even though it is in an exposed area, the scarring will be quite acceptable. Skin closure of these facial lesions excisions is often done in a subcuticular technique so no sutures need to be removed and no suture track marks all be left behind.
Dr. Barry Eppley
Indianapolis, Indiana