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Functional and Esthetic Forehead Reconstruction Using Pre-Expanded Scalp Flaps Combined With Laser Hair Removal
Xinyue Dai1, Zixuan Zhang, Shengyang Jin
1Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shijingshan District, Beijing, China.
Background:
Forehead reconstruction presents a significant challenge for plastic surgeons. The scalp is an ideal donor site for flaps, except for the presence of hair. Laser hair removal is a safe technique for removing hair from the scalp. In this study, the authors aimed to present their experience with forehead reconstruction using a preexpanded scalp flap combined with laser hair removal.
Methods:
A total of 24 patients underwent forehead reconstruction using pre-expanded scalp flaps combined with laser hair removal between June 2005 and February 2024. The surgical procedure consisted of 3 stages. In the first stage, a tissue expander was placed beneath the scalp. After removal of the expander, the pre-expanded scalp flap was advanced anteriorly to resurface the forehead defect. Approximately 3 months postoperatively, patients received multiple sessions of 755 nm alexandrite laser hair removal. Aesthetic outcomes were blindly assessed by 2 plastic surgeons and categorized as poor, fair, good, or excellent.
Results:
One patient experienced epidermal necrosis of the flap, and another experienced flap tip necrosis following laser therapy; both healed with conservative treatment. Transient limitation in eyelid elevation occurred in 2 patients and resolved spontaneously 1 month after surgery. Flap dimensions ranged from 8 × 7 cm to 22 × 8 cm. The number of laser hair removal sessions ranged from 2 to 6 (mean: 4.88). After 12 to 52 months of follow-up, all outcomes, including flap color, texture, epilation, and thickness, location and symmetry of the eyebrow and hairline, and scar concealment, were rated as good or excellent. No patients reported abnormal frontalis function or sensory recovery of the forehead. All patients expressed satisfaction with their outcomes.
Conclusions:
A pre-expanded scalp flap combined with laser hair removal represents a viable option for forehead reconstruction, especially for large defects. Future studies should focus on optimizing laser parameters to maximize efficacy while minimizing complications.
