Mr. Onur Gilleard
Qualifications & Experience
Mr Onur Gilleard is a distinguished consultant plastic surgeon on the GMC specialist register. He previously held an NHS consultant post at St Bartholomew’s Hospital in London, specialising in skin cancer and microsurgical reconstruction. In 2021, Mr Gilleard transitioned from the NHS to dedicate himself fully to private practice, allowing him to focus exclusively on providing personalised, high-quality care to his patients. He is recognised as an expert in laser treatments, having conducted research and developed advanced treatment protocols using cutting-edge laser technology to optimise both clinical outcomes and cosmetic results.
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Two lipomas of identical size can be entirely different operations depending on where they sit. What changes is not the lump but what lies underneath it — and how much slack the skin above it has. Three factors decide the difficulty: proximity to a named nerve, depth relative to the muscle fascia, and how much tension the wound will be under afterwards.
The Three Things That Make a Site Difficult
- What is beneath it. A lipoma sitting over muscle in the middle of the thigh has nothing important below it. One at the elbow or the back of the knee sits within millimetres of nerves that matter, and the dissection has to respect that.
- How deep it goes. Above the fascia is straightforward. Beneath it, or within muscle, is a different operation — longer, achier, and often imaged first rather than discovered during.
- How much the skin moves afterwards. Back, shoulder and chest wounds are pulled on constantly. That tension is what widens a scar, and it is the reason two identical excisions can leave very different lines.
Site by Site
| Site | Difficulty | What actually drives it |
|---|---|---|
| Upper back, shoulder | Straightforward surgically, demanding cosmetically | Thick skin, no critical structures — but the highest wound tension anywhere on the body, so the scar spreads if the two-week restriction is ignored |
| Upper arm, forearm | Usually the easiest | Mobile skin, easy access, few structures at risk above the elbow |
| Thigh, buttock | Straightforward | Generous soft tissue. Comfortable at rest, sore on sitting and stairs |
| Neck | Higher | Nerves, vessels and glands in a small space; skin is thin and the scar is visible |
| Elbow, back of knee, armpit, wrist | Higher | Named nerves and vessels run superficially here; anatomy governs the approach more than technique does |
| Face | Higher | Facial nerve branches, thin skin, and a scar nobody can cover |
| Hand and foot | Higher | Little spare tissue, tendons and nerves close by, and wounds that move with every step or grip |
| Chest wall | Moderate | Constant movement with breathing; tension similar to the back |
| Groin, navel, abdominal midline | Assessed differently | Not primarily a difficulty question — a hernia must be excluded first |
| Deep or intramuscular, any site | Highest | Imaging before surgery, a longer recovery, and often a general anaesthetic — done in the clinic’s own theatre at Harley Street rather than referred out |
Why Nerve Proximity Matters More Than Size
Every lipoma excision divides small sensory nerve branches running through the fat — which is why a patch of numbness around the scar is close to universal and usually settles over six to twelve months.
What is different at certain sites is that a named nerve runs nearby, superficially enough to be at risk. The ulnar nerve at the elbow, the common peroneal nerve at the outer knee, the brachial plexus branches in the armpit, the facial nerve branches in the cheek: injury here can cause lasting numbness in a defined territory or, rarely, weakness rather than just altered sensation.
This is why a 3 cm lipoma at the elbow can warrant more planning than a 7 cm one on the back. It also explains why the honest answer to “can you just take it out today?” is sometimes no.
Above or Below the Fascia
The single most useful distinction, and one you can partly assess yourself. A lipoma in the subcutaneous fat slides freely under the skin and stays mobile when you tense the muscle beneath it. One that becomes fixed or harder to feel on muscle contraction is sitting deeper.
Deep and intramuscular lipomas are still benign, but they change three things: imaging is arranged before surgery rather than after, the dissection involves tissue that moves constantly, and recovery is longer and achier because muscle was involved rather than just the fat above it. The self-assessment is set out in what mobility tells you.
Where the Scar Behaves Worst
Surgical difficulty and cosmetic difficulty are not the same list. The back and shoulder are technically easy and cosmetically demanding — there is nothing dangerous underneath, but the skin is under constant tension and spreads a scar that would have stayed fine on a forearm.
Three sites deserve a specific warning: the shoulder, the upper back and the sternum, which are also the classic sites for hypertrophic and keloid scarring. If you have scarred badly before, that changes how the site is managed rather than whether surgery is offered — and it is worth raising at the consultation rather than afterwards.
Across every site, the intervention that matters most is the same: keeping the wound out of tension for two weeks. It influences the final scar more than the technique used to make it.
When a Clinic Room Is Not the Right Place
Most lipomas are removed comfortably under local anaesthetic at 101 Harley Street in 20 to 45 minutes. Some are not, and saying so at the consultation is more useful than discovering it halfway through:
- Lesions lying deep to the fascia or within muscle
- Very large lipomas, where the total dose of local anaesthetic becomes the limiting factor
- Several large lipomas in one sitting, for the same reason
- Lipomas sitting directly on a named nerve or major vessel
- Anything where imaging has raised a question about the diagnosis
In those cases the answer is a general anaesthetic rather than a different clinic: the procedure is booked into the clinic’s own main operating theatre at 101 Harley Street, with its own anaesthetists and equipment. The setting changes, the surgeon does not.
What Happens Instead — and It Is Not a Referral
A general anaesthetic is recommended where the lipoma is very large (over roughly 10 to 15 cm), sits deep to the fascia, is fixed rather than mobile, lies close to major nerves or vessels, or where imaging has shown atypical features.
Those operations are not sent elsewhere. They are done under general anaesthetic in the clinic’s own theatre at 101 Harley Street, by the same surgeon, with the clinic’s own anaesthetists. The only thing that changes is the setting and the anaesthetic — not the team.
There is one genuine exception, and it is a different situation altogether: a lump with features suspicious for a sarcoma is not removed here at all, at any size, and is referred directly to a specialist sarcoma unit.
Does Site Change the Cost?
The published prices are £100 for the consultation, £450 for the removal and £350 for each additional lipoma at the same appointment. Where a lesion needs imaging first, or is better done under general anaesthetic, that is discussed and quoted at the consultation rather than assumed — and it is a conversation worth having before booking rather than after. Book: lipoma removal or contact the clinic.
In practice: a superficial lipoma under 5 cm is £450 wherever it is. Where a general anaesthetic is needed, the price is quoted individually, because it has to cover the anaesthetist, a surgical assistant where one is required, any specialist equipment and the total theatre time. Site matters to that calculation only insofar as it drives the decision about anaesthetic.
Removal is available at all three clinics — Harley Street, St Albans and Guildford — but general anaesthetic cases are done at Harley Street only. A lipoma that is large, deep to muscle, or in the head and neck area is therefore usually booked there from the outset.
Common Questions
- Which lipoma locations are riskiest to remove?
- Those where named nerves and vessels run superficially — the elbow, the back of the knee, the armpit, the wrist, the neck and the face — along with any lipoma lying deep to the muscle fascia. Difficulty is driven by what is underneath the lump rather than by its size.
- Is a lipoma on the back easy to remove?
- Surgically, usually yes: thick skin and nothing critical beneath it. Cosmetically it is one of the more demanding sites, because back and shoulder wounds are under constant tension and spread if the two-week restriction on gym, lifting and stretching is ignored.
- What about a lipoma on the neck?
- Assessed more carefully. Nerves, vessels and glands sit close together in a small space, the skin is thin and the scar is visible. Not a reason to avoid removal, but a reason for it to be planned rather than squeezed in.
- How do I know if mine is deep?
- A superficial lipoma slides freely and stays mobile when you tense the muscle underneath. One that becomes fixed or harder to feel on muscle contraction is likely deeper, and that is worth mentioning at the consultation because it usually means imaging first.
- Can removal damage a nerve?
- Small sensory nerves are inevitably divided, which is why numbness around the scar is expected and usually settles over six to twelve months. Injury to a named nerve is uncommon and depends mainly on the site, which is why anatomy governs the plan at the higher-risk locations.
- Are facial lipomas treated differently?
- Yes. Facial nerve branches, thin skin and an unconcealable scar mean the incision is planned around the anatomy and the natural creases, and closure matters more than anywhere else.
- There is a lump in my groin. Is that a difficult site?
- It is a different question rather than a harder one. A hernia has to be excluded first, because some hernias contain nothing but fat and feel exactly like lipomas — see lipoma or hernia.
- Will I need a general anaesthetic?
- Most lipomas are removed under local anaesthetic in the clinic. A general anaesthetic is considered for lesions that are deep or intramuscular, very large, numerous in one sitting, or sitting directly on a named nerve or vessel.
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