Forehead Reduction Using the Subsuperficial Galea Dissection Plane

Forehead reduction with hairline advancement is a well-established procedure for correcting a congenitally high or surgically elevated hairline. The standard surgical approach, described consistently throughout the published literature, involves elevation of the scalp flap in the subcutaneous plane. The frontalis muscle varies considerably in width, depth, and presence across the forehead and fades gradually at the central bifurcation found in a substantial proportion of individuals. In some cases, this may cause the inadvertent elevation of parts of the muscle when performing multiple deep tissue manipulations involving the frontalis muscle. We present a technique for reliably maintaining a single, consistent dissection plane (subsuperficial galea) throughout the forehead, to produce a flap of uniform thickness and composition that we hypothesize may reduce postoperative contour irregularity after multiple deep plane manipulations. Following standard incision and hairline marking, dissection is carried in the subsuperficial galea plane immediately superficial to the frontalis muscle, using the muscle's characteristic glistening, striated surface as a continuous landmark. Through the midline bifurcation, where this landmark is absent, plane depth is maintained by reference to the plane already established on either side and by tactile assessment of tissue thickness and tension. The supraorbital and supratrochlear neurovascular bundles are identified as they perforate the frontalis muscle and are preserved as dissection approaches the brow. Deliberately and consistently maintaining the dissection plane (subsuperficial galea plane) throughout the forehead, with specific attention to the bifurcation zone, produces a flap of uniform thickness and, based on our clinical impression, may reduce the visibility of postoperative contour irregularities. We present the anatomical rationale and step-by-step technique to allow evaluation and reproduction by other surgeons.