Spindle cell lipoma is a distinct entity of lipomatous tumor, that typically arises in the subcutaneous tissue of the posterior neck and shoulder. Lipomas found in the Oral & Maxillofacial region rarely reach a size larger than 2cm. Challenging surgical decision-making as in the present case appears in the aesthetic cheek zones which are highly visible and important parts of a person’s countenance. The role of natural line in the complete resection of this neoplasm with minimal risk of recurrence and its clinicopathologic characteristics is highlighted. 

A 55-year-old diabetic, hypertensive obese man presented with a huge asymptomatic slow-growing cheek mass compromising facial aesthetics and discomfort in mastication.  MRI was suggestive of an atypical lipomatous tumor with suspicion of intramuscular involvement. Gross examination showed a soft multilobulated mass measuring 8.0cm in maximum dimension with a brownish jelly-like material. The tumor was successfully removed with no post-operative complications. The histopathological and immunohistochemical analyses confirmed its diagnosis. 

Due to the lesion being located subcutaneously, a technique via nasolabial incision approach satisfies the need for surgical exposure and facilitates operative performance. The scar was expertly placed and hidden in a natural appearing skin crease and virtually impossible to see, thus named a “natural line” incision. 

A wider intraoral incision potentially would pose a danger to the facial nerve and parotid duct. Operations to maintain and improve function are not feasible without incisions and the subsequent formation of scars. Therefore, a cosmetically pleasing incision should be used. It requires experience, detailed knowledge and careful planning to achieve the intended improvement of function with a minimal loss of aesthetics.

Born and raised in Sabah, also well known as ‘’The Land Below the Wind’’, Dr Michelle obtained her Bachelor of Dental Surgery BDS from SDM College of Dental Sciences & Hospital India in 2017 with first-class honors. She has been proudly serving the Ministry of Health of Malaysia for 6 years as a permanent resident doctor/dentist in the Department of Oral & Maxillofacial Surgery, Hospital Queen Elizabeth, Sabah. Having learnt a great deal about hospital-based dentistry, she now has a clear vision in delivering transformational outcomes in Head & Neck Oncology research. 

Dr Michelle is actively involved in research activities and won first prize in a poster presentation titled ‘Multiple Recurrent Eosinophilic Ulcers of the Oral Mucosa in a Patient with Crouzonoid Facies: Case Report of a Rare Association’ at the 5th Northern Zone Sarawak Research Day 2020 followed by first prize in a poster presentation titled ‘Nasolabial Incision: A Natural Line to Facilitate Removal of a Huge Spindle Cell Lipoma of Cheek’ at the 9th Sabah Research Day 2022.