Multiplane Forehead Shortening: Sparing the Frontalis Muscle and Supraorbital Nerve

BACKGROUND: An appropriate forehead-to-face ratio is an important factor contributing to a balanced and attractive face. Conventional methods have been used to correct long forehead, but these methods have drawbacks. The primary objective of this study was to introduce a modified technique with better results. METHODS: Between March of 2015 and March of 2017, 525 patients with long forehead underwent multiplane forehead shortening with sparing of the frontalis muscle and supraorbital nerve. The operation began with a design indicating the area of skin excision. The sensory nerves were preserved during the skin excision, and the frontalis muscle was not cut. Subgaleal dissection was performed through a small window on the galea. The postoperative assessments included the change in forehead length, sensory changes on the scalp, the presence of a scar, alopecia, and synchronous movement of the flap. RESULTS: A mean forehead shortening of 2.0 cm (range, 1.1 to 2.8 cm) was observed. Sensory deficits were observed only in the anteromedian scalp, which the supratrochlear nerve innervates. However, sensation recovered to the normal level within 6 months. Scars were barely visible or not visible at all in 85.5 percent of the patients. Postoperative alopecia occurred in only two cases. The synchronous movement of the forehead and scalp was natural in all cases. CONCLUSION: This modified technique of multiplane forehead shortening with sparing the frontalis muscle and supraorbital nerve provided both cosmetic and functional benefits. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.