The forehead as one of the major aesthetic units of the face presents certain challenges
for reconstructive surgeons. These are the followings: a) maintaining the normal boundaries
of the unit, specifically the temporal and frontal hairlines, as well as brow symmetry;
b) preserving motor nerve and if possible, sensory nerve function; and c) optimal
placement of surgical scars (brow, relaxed skin tension lines (RSTL), hairline). Forehead
reconstruction is completed with much greater wound tension than other facial sites
because of the paucity of available tissue and the proximity and immobility of the
underlying structures. Brow elevation is often a problem with many closure options.
The brow ist best dealt with as „free margin“ similar to the lip and alar rim. Midline
defects can be closed vertically or horizontally. Paramedian forehead defects are
ideally closed fusiform in the transverse RSTL. For lager defects, uni or bilateral
advancement flaps can be used. There are many reconstructive options for lateral forehead
defects. Primary repair using RSTL is the closure of chice. If not appropriate or
possible falp repair should be the next consideration. Rotation, advancement and transposition
flaps can be developed based on the excess tissues of the temple. Undermining is done
with caution because of increased risk for motor nerve damage. Second intention healing
or grafts are not a first choice option for significant forehead defects, but may
be used for the lateral forehead defects because of its concavity. Here we demonstrate
reconstructions of patients with forehead defects.
