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Background: The forehead occupies a full one-third of the face’s surface area. Its borders are the hair-bearing areas of the frontal hairline superiorly, the eyebrows inferiorly and the temporal hairline laterally. The frontal hairline determines the vertical length of the forehead. The eyebrows provide facial expression and create a emotional appearance. The forehead bone determines the projection and contour of the otherwise amorphous same color surface.

Forehead reshaping surgery consists of a variety of procedures including bone reduction/reshaping, bone augmentation, forehead reduction by frontal hairline advancement and brow lifting surgery. While these forehead reshaping procedures are well known to be done alone, they can also be done together to create a more dramatic overall forehead reshaping effect.

Of all the forehead reshaping procedures the one that requires some preparation is the frontal hairline advancement. Moving the frontal hairline forward (or lower) relies on the natural elasticity of the scalp. (the ability of the scalp to stretch) This is not the same for all patients. Thin caucasian females have the least scalp flexibility in my experience and usually needs assistance to make a significant frontal hairline movement.

Case Study:  This young female was bothered by her existing forehead. It was vertically too long with a high hairline. The long forehead also had a significant protrusion. (bulging). Lastly she had low eyebrows with a flat shape. A comprehensive forehead reshaping plan consisted of bony reshaping, hairline advancement and a browlift.

But because of her thin and tight scalp a first stage scalp expander was placed. It was placed in the occiput and was inflated to 150ccs six weeks prior to the second stage total forehead reshaping operation.

Under general anesthesia a frontal hairline incision was made into the temporal regions. Through this incision the scalp expander was removed which provided 15mms of forward movement of the frontal hairline. Raising the forehead tissues down to the brows, the forehead bossing was reduced. The union of the frontal hairline advancement and the excised upper forehead skin also created the browlift with emphasis on lifting the lateral brows.

Total forehead reshaping can be done by combining the three known forehead procedures. They all can be done through a single frontal hairline incision. The key in the frontal hairline advancement is to create the anterior scalp movement needed. When in doubt an occipital scalp tissue expander provides the scalp mobility needed.

Case Highlights:

1) The most effective hairline advancements in thin scalps use as first stage scalp expansion.

2) Forehead bone reshaping can be effectively done through a frontal hairline incision.

3) A browlift can also be done at the same time as a hairline advancement and forehead reshaping.

Dr. Barry Eppley

Indianapolis, Indiana

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