Vertical forehead reduction is a soft tissue forehead reshaping procedure that shortens the distance between the frontal hairline and the eyebrows. It does so through a combination of forehead skin removal and hair-bearing scalp advancement. It also needs to do so without causing substantial brow elevation (unless that is desired) as well as prevention of undue tension on the incisional closure to avoid wide scarring and hair loss.
In most frontal hairline advancements the goal is often to achieve maximal movement of the hairline forward. (technically downward as well) Typical advancement distances are usually in the range of 10 to 15mms at a minimum. While complete undermining of the scalp back to the occiput provides the much needed tissue mobilization, the skin closure is never completely tension free.
As a result it is important to provide a point of firm fixation of the frontal hairline at the bone level. This keeps tension off of the skin closure for the best scar result. One technique of scalp flap fixation is the use of bone tunnels through which sutures are passed. Using three points of scalp flap fixation at the location of the new hairline a solid fixation is achieved by the sutures passed through the bone and up through the galea. Such bone tunnels pass only through the outer skull cortex.
Once the advanced scalp flap is secured, the overlapping forehead skin can be marked and removed at the location of the new frontal hairline. This allows for the least amount of tension as opposed to doing the reverse…set the forehead reduction level and try and make the scalp flap advanced to it.
Dr. Barry Eppley