What is the treatment for lipomas (fatty tumors) behind both ears?

Treatment of Lipomas Behind the Ears

Surgical excision is the recommended first-line treatment for symptomatic lipomas behind the ears, with standard wide excision providing the lowest recurrence rate of approximately 3.3%. 1

Diagnosis and Evaluation

Before proceeding with treatment, proper diagnosis is essential:

• Lipomas typically present as round or ovoid, well-circumscribed soft tissue masses
• They are mobile when manipulated and have a soft, doughy consistency on palpation
• A yellow hue may be visible in some cases
• Ultrasound is recommended as the first-line imaging tool for evaluation
• MRI provides the most accurate information for diagnosis and surgical planning in cases of diagnostic uncertainty

Treatment Options

1. Surgical Excision (Primary Recommendation)

• Standard wide excision: Removal of the tumor with a rim of normal tissue around it

  • Associated with lowest recurrence rate (approximately 3.3%)
  • Recommended for symptomatic lipomas
  • Complete removal provides excellent long-term outcomes 1

• Minimally invasive techniques:

  • The "one-inch method": Resection through a one-inch incision after blunt dissection
    • Particularly useful for cosmetically sensitive areas like behind the ears
    • May have limitations based on anatomical location 2
  • Liposuction-assisted removal: May be considered for larger lipomas in cosmetically sensitive areas 1

2. Injectable Treatments (Alternative Option)

• High-frequency ultrasound-guided injection using Class III CE-marked devices (e.g., Aqualyx™)
  • Complete removal achieved in 70.59% of cases
  • Significant size reduction in the remaining 29.41%
  • Recommended as a non-invasive alternative when surgery is undesirable 3

3. Observation

• Small (<5 cm), asymptomatic lipomas can be safely observed
• Surgical referral is indicated if there is:
  • Growth in size
  • Pain
  • Cosmetic concerns
  • Functional interference 1

Special Considerations for Lipomas Behind the Ears

Lipomas in the auricular region require special attention:

• The conchal region of the ear is a rare but documented location for lipomas 4
• Due to the proximity to important structures (facial nerve, auditory structures), careful surgical planning is essential
• The cosmetic outcome is particularly important in this visible area
• Consider minimally invasive techniques when appropriate to minimize scarring

Postoperative Care

• Inspect the surgical site for complete wound closure and proper healing
• Monitor for signs of infection
• Manage pain using a multimodal approach
• Educate patients on the normal healing process and activity restrictions
• Schedule follow-up to assess wound healing and review histopathology results 1

Prognosis and Follow-up

• Long-term follow-up is warranted as recurrences can occur late (mean 4.7 years after resection)
• Subcutaneous lipomas have an excellent prognosis with a low risk of malignant transformation
• Patients should report any clinical suspicion of recurrence 1

Pitfalls and Caveats

• Ensure proper diagnosis before treatment - distinguish lipomas from other masses like vestibular schwannomas, which may present in similar locations but require different management 5
• Consider the cosmetic impact of any surgical intervention in this visible area
• Be aware that incomplete excision increases recurrence risk
• For deep-seated lipomas or those with atypical features, more extensive imaging and possibly biopsy may be required before treatment