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Multi-fragment Onlay Reconstruction in Forehead Contouring Surgery: A Novel Hardware-Free Technique for Frontal Sinus
Mehmet Fatih Okyay1, Fatih Cinar2
1MFO Private Plastic, Reconstructive and Aesthetic Surgery Clinic Antalya, Antalya, Turkey.
Background:
Forehead contouring plays a pivotal role in craniofacial and aesthetic plastic surgery, particularly in patients undergoing facial feminization or seeking correction of frontal bossing. Traditional methods often rely on anterior frontal sinus wall osteotomy with titanium plate fixation, which, while effective, carries risks, such as foreign body reaction, infection, hardware palpability, and interference with natural bone healing. To address these limitations, we propose a hardware-free technique utilizing multi-fragment onlay reconstruction following sinus obliteration.
Methods:
Between January 2020 and December 2022, 24 patients (17 female, 7 male) underwent forehead contouring using the multi-fragment onlay method. The frontal sinus anterior wall was osteotomized and reshaped into multiple fragments. The sinus cavity was obliterated with bone wax to provide a stable, biologically inert base. Bone fragments were then reassembled in a puzzle-like configuration without the use of titanium fixation. Postoperative outcomes were evaluated using 6-month CT scans and the FACE-Q aesthetic satisfaction questionnaire.
Results:
No major intraoperative or postoperative complications were observed. Radiologic evaluations confirmed stable bone integration in all patients. The FACE-Q results showed ''very satisfied" ratings in 23 of 24 patients; one patient reported mild asymmetry dissatisfaction. No cases of infection, mucocele, CSF leak, or bone resorption were identified. Elimination of hardware reduced cost and improved biocompatibility.
Conclusion:
The multi-fragment onlay reconstruction technique represents a safe, effective, and biologically favorable alternative to titanium-based forehead contouring. This approach offers precise aesthetic outcomes, avoids foreign materials, and demonstrates excellent patient satisfaction. It is best suited for patients without prior frontal sinus pathology or surgery.
Level Of Evidence Iv:
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
