Patient Success Story: How a Hidden Incision Helped One Patient Keep Her Smile

Madi Carter, a woman in her 20s with a public-facing job as a server and bartender, came to Tahoe Forest Hospital after noticing a lump on her right cheek that had been slowly growing. As someone who interacts with customers daily, Madi was understandably concerned; not only about what the lump might be, but also about how treatment might affect her appearance and confidence at work.

Under the care of Dr. Hoff, the team at Tahoe Forest conducted an ultrasound and a fine needle biopsy, which revealed that Madi had a tumor on her parotid gland, one of the salivary glands located just in front of the ear. While the tumor itself was benign, it needed to be surgically removed. That alone would be daunting news for any patient, but for someone whose facial expressions are part of their daily work, it was even more important to consider both medical and cosmetic outcomes.

The complexity of the surgery came down to anatomy. As Dr. Hoff explained, “The facial nerve comes out right near the ear and extends into five branches to control every movement over your face: your eyebrows, your eye closure, your smile, your frown. Any asymmetry there or any kind of nerve weakness is very apparent.” In other words, removing the tumor safely meant navigating very close to the nerve that controls all of Madi’s facial movements. One wrong move could leave lasting effects on her expression, speech, and confidence.

Traditional surgical approaches to removing parotid tumors often involve a visible incision that travels in front of the ear and down into the neck. This is an effective method, but one that leaves a more prominent scar. Dr. Hoff, recognizing Madi’s concerns and values, made a different choice. “I did the same approach that you would use to give somebody a facelift with a hidden scar,” he said. The incision, rather than being placed front and center, was curved behind the ear and into Madi’s hairline and essentially invisible to a casual observer.

The results were everything Madi had hoped for. “We were able to get the entire tumor out,” Dr. Hoff said. “And she had no weakness of her facial nerve, which was honestly our biggest concern.” Madi healed beautifully, and, in Dr. Hoff’s words, “She does have a scar, but it’s very difficult to see. Somebody would have to be looking very closely.”

Madi was thrilled with the outcome. “I am deeply grateful for the exceptional support and care I received from the medical teams at Tahoe Forest Hospital, with special appreciation for Dr. Hoff,” she said. “From the moment the lump was discovered, through the uncertainty of its severity, to learning of the risks posed by its proximity to my facial nerves, the process was understandably stressful. Throughout this time, Dr. Hoff provided reassurance, explaining his commitment to removing the tumor entirely while preserving my facial nerves. His expertise and skill led to a highly successful outcome, for which I am truly thankful. I feel fortunate to have been under the care of such a talented and compassionate physician, and I extend my sincere thanks to Dr. Hoff and the outstanding staff at Tahoe Forest Hospital.”

Dr. Stephen Hoff, Board Certified Otolaryngologist

While the surgical approach Dr. Hoff used isn’t brand new, it hadn’t been performed at Tahoe Forest before. Most importantly, it was about making the best possible decision for this individual. “It was more patient-centered care where we made an individual plan. The team prioritized Madi’s full recovery, both physical and emotional,” Dr. Hoff said.

Madi’s story is just one example of the thoughtful, personalized care that Tahoe Forest is building as it expands its ENT surgical services. With specialists like Dr. Hoff on board, patients in the Tahoe Truckee region can access advanced, minimally invasive procedures without needing to leave their community.