Surgical management of large venous malformations of the lower face.

We describe the benefits of an early surgical approach to large (more than 3 cm) venous malformations in the lower face, and discuss the advantages over conservative treatment. Fifty-eight patients with venous malformations of the lower face were treated in this hospital between 2005 and 2010 with sclerotherapy (lipidocanol), or laser, or resection, or all three. Only patients with recurrent malformations and a history of previously ineffective conservative treatment were included in the study (n=17). Follow-up ranged from 23-65 months (mean 40). Functional and cosmetic outcomes and recurrence were recorded on a single questionnaire. Seventeen patients with a history of recurrent malformations, which had previously been treated ineffectively with conservative treatment and were more than 3 cm in diameter, benefited from early and wide resection. No recurrences were recorded during follow-up. Patients were satisfied with the postoperative cosmetic and functional results. Large malformations are both deforming and functionally disabling. These patients, who initially do not respond to conservative treatment, benefit from early definitive resection. LEVEL OF EVIDENCE: 4 (case series with comparison).