Background: Primary miliary osteoma cutis is characterized by de novo bone formation in skin without a known associated or pre-existing cutaneous disorder. These lesions often develop on the face and cause cosmetic concern. Objective: Multiple treatments have been attempted, including topical and systemic agents and surgical techniques. The ideal treatment modality should be simple and effective with minimal side effects. Methods: The technique of scalpel incision over visible lesions, curet extraction of bony fragments, and primary suture repair was used to remove multiple lesions of primary miliary osteoma cutis on the cheeks of an affected patient. Results: This surgical technique resulted in a significant reduction of visible and palpable lesions and a smoother surface contour with minimal scarring. Conclusion: This surgical technique offers a simple but effective method for removal of multiple bony fragments in primary miliary osteoma cutis with minimal side effects. (J Am Acad Dermatol 2001;44:96-9.)