Forehead Reduction Surgery: Outcomes and Complications of 650 Cases in a Multiracial Population.

BACKGROUND

Forehead reduction surgery (FRS) is gaining popularity as a cosmetic procedure for individuals with disproportionately large foreheads.

METHOD: A retrospective review was conducted on patients who underwent FRS from April 2018 to May 2023. Data included sex, age, ethnicity, facial thirds measurement, forehead reduction, dehiscence, hematoma, infection, seroma, and necrosis. Patients with > 12-month follow-up (N = 287) were further analyzed for folliculitis, alopecia, postoperative effluvium, scar quality (SCAR scale) and patient satisfaction (5-point Likert scale).

RESULTS

A total of 650 patients (95.5% female) underwent FRS, with an average skin excision of 2.29 cm, representing a 28% forehead reduction. Black ethnicity was associated with greater reductions, with an average advancement of 2.52 cm (p < 0.001). Complications included 14 cases of dehiscence, 6 seromas, 1 necrosis, 133 cases of folliculitis, 98 of postoperative effluvium, and 1 of alopecia. Men had significantly fewer cases of effluvium (p = 0.016). All scars were evaluated as good quality. White ethnicity and reductions exceeding 2.3 cm appeared to increase the risk of scar revision, though not statistically confirmed.

CONCLUSIONS

FRS is an effective and safe technique with few complications and high patient satisfaction. It is essential to manage expectations and educate patients on the limitations, particularly regarding forehead shortening, correction of temporal recesses, scar development, and more frequent complications such as folliculitis. Patient selection should focus on capillary diseases that may impact long-term outcomes, such as male pattern baldness and frontal fibrosing alopecia, as well as addressing unrealistic expectations regarding the results.

LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .