Peri-Eyebrow Incision: A Practical and Aesthetic Solution for Forehead Lipoma Surgery

Background/Objectives: Forehead lipomas are benign but cosmetically conspicuous. Direct transcutaneous incision allows easy removal but often leaves visible scars. Hairline approaches conceal scars but are unsuitable for bald or high-hairline patients and lower forehead lipomas. We evaluated a peri-eyebrow approach using a superior brow-margin incision versus conventional methods. Methods: We retrospectively reviewed 176 patients who underwent forehead mass excision between 2008 and 2025. After exclusions, 97 biopsy-proven lipomas were analyzed (peri-eyebrow 22; hairline 38; direct 37). Variables included lipoma location, vertical ratio (lipoma position between the hairline and eyebrow), lipoma size, and incision length. Logistic regression assessed the relationship between vertical ratio and peri-eyebrow incision selection. Multivariate logistic regression identified independent predictors, and bootstrap validation (1000 iterations) assessed the internal stability of the ROC cut-off. Scar quality was evaluated using the Patient and Observer Scar Assessment Scales. Results: Peri-eyebrow incisions were used only for midline or median lipomas. The vertical ratio was highest in the peri-eyebrow group (0.70 ± 0.10) and independently predicted incision choice (adjusted OR per 0.1-unit increase 3.32, p < 0.001). ROC analysis showed excellent discrimination (AUC 0.872), and the bootstrapped AUC (0.802, 95% CI 0.727-0.878) confirmed robust internal validity. The optimal 0.615 cut-off yielded 0.82 sensitivity and 0.79 specificity. Peri-eyebrow and hairline incisions achieved significantly better scar scores than direct incisions (p < 0.001). Conclusions: The peri-eyebrow incision is a safe and cosmetically effective alternative when hairline incisions are unsuitable. It offers concealed scars and outcomes comparable to hairline incisions.