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Ramin A. Behmand, M.D.
Plastic & Cosmetic Surgery
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1776 Ygnacio Valley Rd, Suite 108
Walnut Creek, California 94598
Tel: (925) 939-9200
1776 Ygnacio Valley Rd, Suite 108, Walnut Creek, California  94598
Telephone: (925) 939-9200  Facsimile: (925) 939-9205

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Shortening Of The Long Forehead

Guyuron B., Behmand R.A., Green R.

A long forehead disrupts the harmony among the facial components and may
contribute to the semblance of facial aging. Slight forehead length disharmony
on a senescent face can be corrected by placing the incision at the hairline,
elevating the eyebrows through subcutaneous or subgaleal dissection, and
removing excess skin without posterior scalp immobilization. For moderate
to major reduction of the forehead length, the scalp is elevated back to the
occipital region through a pretrichial incision, and relaxation incisions are
made at a right angle to the vector of advancement. The entire scalp is then
repositioned anteriorly, advancing the hairline caudally and shortening the
forehead. Retraction of the scalp or excessive elevation of the eyebrows is
prevented by anchoring the galeal fascia to the cranial bone using a
bone-tunneling technique in one to three rows. The number of fixation rows is
commensurate to the amount of advancement and rigidity of the scalp. The
more immobile the scalp preoperatively, the more relaxation incisions and
fixation tunnels are necessary. Following caudal repositioning of the scalp, the
non-hair-bearing skin is excised, and a meticulous repair is done. These
procedures have been performed in 180 patients with a high degree of
satisfaction. Temporary hair loss was experienced in one smoker who
underwent the most advancement through posterior scalp elevation and
continued to smoke postoperatively. Also, on three patients in the
subcutaneous forehead rhytidectomy group, two of whom were smokers,
delayed healing was observed in the temple area because of compromised
circulation requiring secondary revision.