Forehead Overfilling After Autologous Fat Grafting: Literature Review and Retrospective Evaluation of MRI-Guided Microliposuction for Revision.

[BACKGROUND] Forehead overfilling after autologous fat grafting (AFG) can persist as a distressing, conspicuous frontal protrusion, yet its occurrence and dedicated subtractive revision strategies remain underreported. This study aims to review the existing literature of forehead AFG and its complications, and to describe and evaluate the efficacy of an MRI-guided, plane-specific manual microliposuction technique for overfilled forehead revision.

[METHODS] A literature review was conducted to summarize the contemporary practices of forehead AFG and postoperative complications. A retrospective review was conducted on patients undergoing MRI-guided revision frontal microliposuction from January 2020 to December 2024. Pre- and postoperative profile photos were used for objective measurement, including forehead convexity angle (FCA) and midforehead protrusion. Patient-reported outcomes were assessed with FACE-Q questionnaires. Postoperative satisfaction was evaluated through three-party ratings.

[RESULTS] The literature review included 32 eligible studies; only 1 reported persistent postoperative overcorrection in a pediatric reconstructive case. A total of 38 female patients were included in the clinical study (median age, 36 years; age range, 23-45 years). Overall, quantitative analyses collectively reflected an objective flattening of the forehead contour, with a significant postoperative increase in FCA (P < 0.001). Complications included temporary upper eyelid swelling (all sessions, all patients, 100%) and short-term neurological dysfunction (first session, 2/38, 5.3%), namely a case of frontalis paresis and another of scalp numbness; all resolved spontaneously. Both FACE-Q and three-party rating results showed high postoperative satisfaction.

[CONCLUSIONS] With disciplined intraoperative maneuvers, microliposuction can safely correct overfilled foreheads with high satisfaction and acceptable risks.

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