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Surgical excision of facial basal cell carcinomas (BCCs) is a balance between oncological clearance and conservation of cosmetic and functionally sensitive tissues.To assess if loupe magnification (LM) can enhance the visual assessment of BCC tumor margins resulting in a greater histological clearance.This prospective study randomized patients with primary facial BCCs into preoperative tumor margin assessment with LM (study group) or clinical examination alone (control group). Basal cell carcinomas were excised with a predetermined surgical margin of either 2, 3,, or 4 mm. Mean histological margin, incomplete excision rate, and method of closure were recorded and compared between LM and control groups, across a range of surgical margins.Ninety-four BCCs were excised from 93 patients, 47 BCCs in each group. The mean histological margin was larger in the study versus control group for each group (2-mm margin, 1.8 vs 1.4, 3-mm margin, 2.4 vs 2.3, 4-mm margin, and 3.1 vs 2.7), but only statistically significant in the 4-mm group (p = .032). There was no difference in method of closure between LM and control groups.Loupe magnification improved tumor margin assessment for facial BCC enabling a greater diameter of histological clearance. The use of LM should become a standard practice for facial BCC excision.