Scalp arteriovenous fistulas (sAVFs) are rare vascular lesions that may cause cosmetic deformity, bruit, headache, and recurrence after incomplete treatment. We report a patient in their 30s with a recurrent left frontotemporal sAVF previously embolized with PHIL 25, who presented with progressive enlargement, audible bruit, and headache. Digital subtraction angiography demonstrated a high-flow fistula supplied by bilateral superficial temporal and ophthalmic artery branches. Direct-puncture embolization with 12 mL of ihtObtura 20 achieved complete angiographic occlusion without complications. Clinical and imaging follow-up at 3, 6, and 12 months showed durable symptom resolution, no recurrence, progressive loss of radiopacity, reduced imaging artifacts, absence of skin tattooing, and volume reduction of the treated mass. This case suggests that ihtObtura may be useful for selected superficial recurrent vascular lesions in which cosmesis, durable occlusion, and artifact-free follow-up imaging are clinically relevant.