Minimal One-Quarter Incision and Four-Step (MOQIF) Excision Method for Subcutaneous Lipoma

Background: Lipomas are common benign subcutaneous neoplasms treated surgically for cosmetic or symptomatic reasons. The minimal one-third incision and four-step (MOTIF) technique provides reliable excision with minimal scarring, but smaller proportional incisions remain unstudied. This study evaluates the minimal one-quarter incision and four-step (MOQIF) technique. Methods: Retrospective review of 82 patients undergoing MOQIF excision of histologically confirmed subcutaneous lipomas by a single surgeon from July 2024–December 2025 was done. Lipomas were stratified by maximum diam-eter: small-intermediate (< 5 cm) and large (≥5 cm). MOQIF used a one-quarter incision of the lipoma’s long axis with four steps: hydro dissection preserving superficial subcuta-neous tissue, superficial dissection, staged deep dissection with selective cautery of fi-brovascular septa, and intact mass delivery. Outcomes included excision length, post-operative complications, Vancouver Scar Scale (VSS) scores, recurrence, and subjective treatment satisfaction of patients. Results: Mean lipoma size was 6.8±2.0 cm (75.6% ≥5 cm). All lipomas were completely excised through 1.69±0.49 cm incisions (ratio 0.25). Com-plications were low: seroma 10.98% (16.7% vs 9.4%, p=0.404), hematoma 7.3% (11.1% vs 6.3%, p=0.608), with no infections, nerve injuries, or recurrences at a mean 8.9 months follow-up. VSS scores were equivalent between groups (0.83 vs 1.06; p=0.438) and overall patient satisfaction were high (3.54 ± 0.53 (2-4)). Conclusions: MOQIF achieves complete lipoma excision through one-quarter incisions with safety and cosmetic outcomes across lipoma sizes matching the previous MOTIF method.