Tension-Free Forehead Reduction Using an Elastic Composite Scalp Flap Anchored to the Bone.

Area of Science:

• Plastic Surgery
• Facial Aesthetics
• Reconstructive Surgery

Background:

• Forehead-to-face ratio significantly impacts facial aesthetics and perceived age.
• Aging, trauma, and alopecia can lead to an enlarged forehead, causing aesthetic concerns.
• Existing hairline lowering and forehead reduction techniques face challenges like visible scarring and limited advancement.

Purpose of the Study:

• To present and evaluate an "elastic" composite scalp flap technique for forehead reduction.
• To assess the efficacy and patient satisfaction with this novel surgical approach.

Main Methods:

• Retrospective analysis of 98 patients (96.9% female) undergoing forehead reduction between January 2021 and December 2024.
• The technique involved an "elastic" composite scalp flap anchored to the frontal bone with tension-free closure.
• Outcomes assessed via photographic evaluation and follow-up (3-48 months) for forehead improvement, scar quality, and patient satisfaction.

Main Results:

• High patient satisfaction reported with stable aesthetic results over the follow-up period.
• Transient sensory disturbances occurred in 91.8% of patients, resolving within 6 months.
• One case (1%) of hypertrophic scarring was the only major complication; no other significant adverse events were noted.

Conclusions:

• The elastic composite scalp flap technique offers a reliable method for forehead reduction.
• The four-step technique (bone tunnels, subperiosteal dissection, periosteo-galeotomies, dual advancement sutures) achieves balanced foreheads with minimal scarring.
• This approach leads to high patient satisfaction and durable aesthetic outcomes.