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Background: The forehead occupies one-third of the face’s surface area. It also has a lot of animation effects from changes in eyebrow position and the creation of various horizontal and vertical wrinkle lines. But short of motion the shape of the forehead and the surrounding hair locations also impact the impression of one’s facial appearance.

The skin surface area is broad on the forehead and is determined by the distance between the fronto-temporal hairline and the eyebrows. The only surgical procedure that can change that relationship is the well known frontal hairline advancement. Relying on the natural elasticity of the scalp, coupled with a wide and deeper release from the skull, the scalp be mobilized to bring the frontal hairline forward. This decreases the vertical forehead length as judged by the distance between the hairline and the eyebrows. While browlifts do not change the amount of forehead skin, it can change the position and shape of the eyebrows on its lower half.

The bony shape of the forehead has a larger number of treatment options for its reshaping including frontal bossing reduction, frontal augmentation, brow bone reduction/augmentation as well as temporal (lateral forehead) augmentation. These number of treatment options combined with forehead reduction by hairline advancement create the opportunity for a more total forehead reshaping.

Case Study: This young male wanted to change the shape of his forehead. He was bothered by his high hairline, prominent brow bones, temporal hollowing and low eyebrows position.

Under general anesthesia a combination of forehead procedures was performed including frontal hairline advancement, horizontal brow bone reduction, placement of extended temporal implants and a hairline browlift. Through upper eyelid incisions the tail of the eyebrow was also vertically reduced.

Total forehead reshaping addresses both bony and soft tissue issues. The number of available forehead reshaping procedures number almost ten different techniques. Putting various of them together creates more of an effect than any one of them alone.

Highlights:

1) Multiple procedures exist to reshape the forehead and change the relationship between the skin and hair bearing structures.

2) The bony central and lateral forehead can be reshaped by augmentation or reduction of the frontal, brow and temporal regions.

3) The surface area of the forehead skin can be changed by altering the position of the frontal hairline.

4) Combinations of bony contour shape changes and the amount of visible skin can be done for a more total forehead reshaping.

Dr. Barry Eppley

Indianapolis, Indiana

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