Selection of Superficial Temporal Artery Flaps for Eyebrow Reconstruction: Two Illustrative Cases

Eyebrow reconstruction remains challenging because an optimal outcome depends on restoring both stable soft-tissue coverage and natural hair-bearing characteristics. Several options are available, including hair transplantation, hair-bearing grafts, local flaps, and hair-bearing fascio-cutaneous flaps based on the superficial temporal artery (STA). Recipient-site and defect characteristics, together with patient factors, guide whether an STA-based flap is indicated. Once an STA flap has been chosen, however, the decision between a pedicled and a free transfer is determined primarily by donor-site availability, namely the condition of the ipsilateral temporal region and its vessels. Explicit decision-making criteria for this two-step reasoning are not well defined.

We present two cases that illustrate flap selection rather than a comparison of techniques. In the first case, a pedicled STA flap was used to reconstruct a partial eyebrow defect when the ipsilateral temporal region was intact. In the second case, previously reported elsewhere, a contralateral free STA flap was used for total eyebrow reconstruction because the ipsilateral temporal region had been compromised by prior surgery.

Both flaps survived completely without major complications. At long-term follow-up, both reconstructions showed restoration of the eyebrow contour with acceptable symmetry, hair direction, and density relative to the contralateral side, and high patient satisfaction.

STA fascio-cutaneous flaps are a reliable option for eyebrow reconstruction. When an STA-based flap is indicated, the choice between a pedicled and a free transfer is governed mainly by donor-site availability: a pedicled flap when the ipsilateral temporal region is preserved, and a free flap when it is unavailable. These cautious, case-based observations are intended to illustrate clinical reasoning rather than to establish the superiority of one technique.