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Background: The large surface area of the forehead creates a major aesthetic component of the face. While lacking the projecting topographies of the lower 2/3s of the face it nonetheless has a few significant features that define it. These include the frontal hairline superiorly, the eyebrows/brow bones inferiorly and the shape of the entire frontal bone across its broad surface.

For a female it is desirous to have a frontal hairline that is not excessively high and is fairly straight from side to side.There should be no evidence of brow bone prominences and the surface of the bony forehead should be slightly convex and smooth lacking any irregularities. The brows should be located over the brow bones edges if not higher.

Forehead reductions consist of a variety of bony and soft tissue changes, all of which if needed can be combined into a single surgery. Once a frontal hairline lowering is needed then every single possible forehead reshaping change can be done through it.   

Case Study: This female desired total forehead reshaping with reduction of upper forehead horns, small medially brow bone prominences and a recessed frontal hairline that was further back in the middle than on the sides. Peroperative markings showed the frontal hairline advancements goals as well as the areas of bony reductions.

Under general anesthesia and through a frontal hairline incision the bony prominences were reduced by high speed burring. The scalp was undermined back to the occiput and advanced 12mm in the middle and less so on the sides.

When seen one week after the surgery for suture removal along the hairline the reshaping of the frontal hairline was apparent as one would expect. The success of the frontal advancement is assured now it is a question of the long term appearance of the frontal hairline scar.

In side view the shape of the forehead has become more vertical with a smoother surface contour. That is as much as a result of the frontal hairline advancement as the bony reductions. The hairline advancement moves over the upper transition of the forehead into the top the head creating a more vertical inclination due to the elimination of this soft tissue area.

With forehead reductions that involve full elevation of the forehead skin with a frontal hairline advancement there is always going to be a bit of inadvertent brow lift as well.

Key Points:

1) Forehead reduction can consist of bone and soft tissue reductions which are in some cases done together for the best aesthetic result.

2) The frontal hairline incision is the best incisional approach for most forehead reductions and the only option if a vertical forehead reduction is needed.

3) Bone burring or shaving is how all bony forehead reductions are done.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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