Shortening of the long forehead

A long forehead disrupts the harmony among the facial components and may co ntribute to the semblance of facial aging. Slight forehead length disharmon y on a senescent face call be corrected by placing the incision at the hair line, elevating: the eyebrows through subcutaneous or subgaleal dissection, and removing excess skin without posterior scalp immobilization. For moder ate to major reduction of the forehead length, the scalp is elevated back t o the occipital region through a pretrichial incision, and relaxation incis ions are made at a light angle to the vector of advancement. The entire sca lp is then repositioned anteriorly, advancing the hairline caudally and sho rtening the forehead. Retraction of the scalp or excessive elevation of the eyebrows is prevented by anchoring the galeal fascia to the cranial bone u sing a bone-tunneling technique in one to three rows. The number of fixatio n rows is commensurate to the amount of advancement and rigidity of the sca lp. The more immobile the scalp preoperatively, the more relaxation incisio ns and fixation tunnels are necessary. Following caudal repositioning of th e scalp, the non-hair-bearing skin is excised, and a meticulous repair is d one. These procedures have been performed in 180 patients with a high degre e of satisfaction. Temporary: hair loss was experienced in one smoker who u nderwent the most advancement through posterior scalp elevation and continu ed to smoke post-operatively. Also, on three patients in the subcutaneous f orehead rhytidectomy group, two of whom Mere smokers, delayed healing was o bserved in the temple area because of compromised circulation requiring sec ondary revision.