Forehead Reconstruction Techniques, Tradeoffs, and Clinical Tips

Conclusions

• Forehead reconstruction is usually best approached by respecting anatomy: preserve the eyebrow as a free margin, avoid unnecessary nerve injury, and account for the forehead’s convex shape and variable skin laxity.
• For most forehead defects, simple linear closure is the commonest solution, and a vertical orientation is generally preferred because it helps avoid eyebrow distortion and usually leaves an acceptable scar.
• If a linear closure would place too much tension on the wound or pull on the eyebrow, an advancement flap is often the preferred next option.
• Transposition flaps can be useful when the goal is to redirect tension vectors and keep suture lines away from the central forehead.
• Granulation can be an option because it avoids additional surgery and the forehead is not the main focus of facial perception, but it requires time and may leave contraction and scarring.
• Skin grafts are easy and can help with tumor surveillance, but on the forehead they often look poor because of indentation and color mismatch, so they are usually a less desirable aesthetic option.
• Thicker-than-traditional Burrow’s grafts may still survive and can preserve contour better than thinned grafts, suggesting that leaving grafts bulkier can sometimes be advantageous on the forehead.
• Very large or complex forehead defects may require combined reconstructive strategies, such as rotation of galeal/periosteal tissue to create a vascular bed followed by grafting.
• In facial reconstruction, the visible quality of the final result is strongly influenced by tension control and contour restoration rather than by the mere presence of a scar.
• The overall theme of the presentation is that forehead reconstruction should be individualized, with technique chosen according to defect size, contour, eyebrow position, tissue laxity, and the need to balance function, blood supply, and cosmetic outcome.