Forehead Length Reduction Surgery: Quantifying Complications and Outcomes Through Systematic Review and Meta-Analysis.

BACKGROUND

Forehead reduction surgery is increasingly performed to improve facial balance and harmony. Although generally considered safe, complication rates and outcomes have not been systematically quantified.

METHODS

A systematic review and proportional meta-analysis were conducted in accordance with PRISMA guidelines. MEDLINE, Embase, Cochrane, Web of Science, and ClinicalTrials.gov were searched through August 2025. Eligible studies included ≥10 adult patients undergoing forehead reduction surgery and reporting at least one complication. Data extraction was performed in duplicate, and the risk of bias was assessed using the Joanna Briggs Institute checklists. Pooled complication rates were calculated using a random-effects generalized linear mixed model, with heterogeneity assessed by I2 statistics.

RESULTS

Fourteen studies involving 3,213 patients were included; most were female and aged 16-76. Most were retrospective case series, with one prospective cohort and one cross-sectional study. The pooled overall complication rate was 5.9% (95% CI, 3.2-10.7%; I2 = 92.4%). Scarring occurred in 5.5%, seroma in 2.4%, folliculitis in 25.1%, alopecia at the incision site in 0.7% (reduced to 0.3% after sensitivity analysis), temporary paresthesia in 97.3%, subsequent hair transplantation in 1.2%, and revision surgery in 1.3%. Patient satisfaction was exceptionally high at 99.9% with minimal heterogeneity (I2 = 6.1%).

CONCLUSION

Hairline-lowering surgery demonstrates a favorable safety profile, with low complication rates, manageable adverse events, and nearly universal patient satisfaction. Clinically, these findings support the procedure as a safe and effective option in contemporary facial aesthetic practice. Future research should incorporate standardized outcome definitions, validated PROMs, and more diverse populations to optimize comparability and generalizability.

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