Shortening of the long forehead.

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.