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Forehead augmentation is most reliably done using different bone-based augmentation materials. Whether it is bone cements or a custom implant design made from the patient’s 3D CT scan, they reliable create forehead shape changes with a strong push off of the bone’s surface. Despite its reliability, implant-based forehead augmentation is not for everyone due to a variety of concerns.

Fat injection forehead augmentation (FIFA) is the alternative and its most common use is in Asian female patients around the world…where forehead augmentation is a common facial feature enhancement request. It can successfully work in many of these patients because the desire is for a more central convexity enhancement of relatively low volume.

In the June 2019 issue of the European Journal of Plastic Surgery an article was published entitled ‘Forehead Biconvexity Enhancement with Fat Grafting’. In this paper the authors describe their clinical experience in over sixty patients (93% female) with fat injection forehead augmentation. The harvested fat was mixed with platelet-rich plasma (PRP) in a 5:1 ratio (Fat:PRP) and injected in small amounts between the dermis and the frontal muscle. Patient satisfaction was evaluated by grading before and and after patient pictures.

The level of patient satisfaction varied with the number of injection sessions. Three injection session patients (8%) were graded as excellent outcomes. Two injection session patients (59%), only one-third (36%) rated their results as excellent. The remaining payments rated it as good or moderate. In single injection session patients (25%), only one-fourth (27%) had excellent results. In regards to forehead wrinkling, nearly three quarters (74%) rated it as a good improvement.

Fat injections are typical viewed and used as a soft tissue augmentation material. While it can be used for traditional bone augmentation sites in the face, its effects are typically perceived as creating a softer rounder contour. As a result fat injections do not do well for jawline augmentation but are somewhat better at cheek augmentation which has a softer shape and can work well in some females.

The forehead has a broader and flatter surface and the use of fat injections is well known to create some limited improved convex shape to it. This softer convex look can work for some females but is not usually a good shape for men. It is not a surprise that multiple fat injections are needed to improve the results in most cases.  While PRP was added to the fat, and the appeal of PRP has always been strong, it is not clear if its addition is responsible for improved graft survival. But at the least as an autologous addition there is no harm in doing so.

The downside to forehead fat injections is that multiple injection sessions may be required and the take of fat is always variable. There is also the risk of overcorrection where fat removal is difficult and may not be successful. But for the female forehead augmentation patient who wants to avoid an implant and has a ow volume need, fat injections are a reasonable option. Interestingly, the occurrence of  reduced horizontal forehead wrinkling is an added aesthetic benefit.

Dr. Barry Eppley

Indianapolis, Indiana

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