Endoscopic excision is a growing treatment option for benign facial tumors; however, its outcome has not been reported in a large series with long-term follow-up. The purpose of this study was to present the outcome of our decade-long experience with endoscopic excision, compared with direct excision.We retrospectively reviewed patients who underwent surgical treatment using either the endoscopic or direct approach for benign facial tumors from January 2001 to January 2012. Patient demographics, complications, recurrence, and pathological results were collected. Patient satisfaction was assessed using survey questionnaires. The results of endoscopic excision and direct excision were compared.Endoscopic excision was performed for 152 patients consisting of 77 lipomas (50.7%), 45 osteomas (29.6%), 24 dermoid cysts (15.8%), and 6 others (3.9%). The masses were located on the forehead in 138 patients (90.8%) and on the cheeks in 14 patients (9.2%). Direct excision was performed for 123 patients composed of 62 lipomas (50.4%), 46 dermoid cysts (37.4%), 11 osteomas (8.9%), and 4 others (3.3%). The mean follow-up period was 4.6 years. In the endoscopic excision group, hematomas developed in 2 and wound dehiscence in 1 patient. In the direct excision group, 1 hematoma and 1 wound dehiscence occurred. There were 4 recurrent cases in the endoscopic excision group and 1 recurrent case in the direct excision group, but there was no statistically significant difference in the recurrence rate between the 2 groups (2.6% vs 0.8%, P = 0.258). Patient satisfaction was higher in the endoscopic excision group than in the direct excision group (satisfaction for aesthetics, 92.98 vs 71.71%, P < 0.001; satisfaction for procedure, 89.9 vs 76.15%, P = 0.001).Compared with direct excision, endoscopic excision provided a comparable recurrence rate and higher patient satisfaction in this decade-long study. Endoscopic excision is a safe and valuable treatment option for selected benign tumors on the forehead and cheek.