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

Introduction: The forehead-to-face ratio plays a crucial role in facial aesthetics, with an increased forehead length often leading to an imbalanced or aged appearance. Factors like aging, trauma, and alopecia contribute to this issue. Surgical techniques for hairline lowering and forehead reduction have evolved, but challenges like visible scars and limited advancement remain. This study presents an "elastic" composite scalp flap technique for forehead reduction.

Methods: A retrospective analysis was conducted involving 98 patients (95 females, 3 males) with a mean age of 35.7 years, who underwent forehead reduction surgery between January 2021 and December 2024. The technique involved an "elastic" composite scalp flap anchored to the frontal bone with tension-free closure. Patients were followed for 3-48 months, and outcomes were assessed through photographic evaluations and follow ups focusing on forehead improvement, scar quality, and patient satisfaction.

Results: A total of 98 patients (96.9% female) underwent forehead reduction surgery, with a mean age of 35.7 years and a follow-up of 3-48 months. High satisfaction was reported, with stable results throughout the follow-up period. Transient sensory disturbances occurred in 91.8% of patients but resolved within 6 months. No major complications were observed, except for one case (1%) of hypertrophic scarring.

Conclusion: The elastic composite scalp flap technique, which consists of four distinct steps including the creation of bone tunnels, performing subperiosteal dissection, executing transverse periosteo-galeotomies, and placing dual rows of advancement sutures, provides a reliable method for achieving a balanced forehead with minimal scarring.

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