Facial Plast Surg 2016; 32(03): 309-314
DOI: 10.1055/s-0036-1579780
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Simplifying Forehead Reconstruction: A Review of More Than 200 Cases

Nicola A. Quatrano
1   Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
*   Nicola A. Quatrano and Tamara B. Dawli contributed equally to this article.
Tamara B. Dawli
2   Section of Plastic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
*   Nicola A. Quatrano and Tamara B. Dawli contributed equally to this article.
Andrew J. Park
3   Department of Surgery, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
Faramarz H. Samie
3   Department of Surgery, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
4   Section of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
› Author Affiliations
Further Information

Publication History

Publication Date:
01 June 2016 (online)


The forehead is a unique facial region with distinct boundaries and variability in shape from patient to patient. When reconstructing the forehead, it is critical to take into account the regional boundaries as their distortion may result in noticeable facial asymmetry. We propose subdividing the forehead into newly defined zones and put forth a rational algorithm for forehead repair based on these divisions. We retrospectively reviewed a single surgeon's (F. H. S.) experience with Mohs excision and immediate reconstruction of the forehead over a 3-year period. A total of 227 consecutive post-Mohs forehead reconstructions were identified, and the reconstructive technique for a given defect size and location and postoperative complications were recorded. The average patient age was 69 years and 114 (50%) patients were female. Reconstructive techniques varied based on defect size and location within the five distinct forehead zones. Primary closure was the favored technique when appropriate, with variation in orientation based on forehead zone. Modified Burow's advancement flap was the most commonly utilized reconstruction for defects of midlateral forehead and suprabrow area, accounting for 51.7 and 62.5% of repairs, respectively. Other techniques included A-to-T flaps, rotation flaps, and full-thickness skin grafting. Using our defined zones, most common repair techniques, and final outcomes, a reconstructive algorithm for post-Mohs excisions on the forehead was derived. Consideration of the five distinct forehead zones and application of an algorithm to guide technique selection for post-Mohs forehead defect repair can lead to consistent results.

  • References

  • 1 Baker SR , ed. Local Flaps in Facial Reconstruction. 3rd ed. Philadelphia, PA: Elsevier; 2014
  • 2 De Abullarade J. Aesthetic considerations in forehead reconstruction in skin carcinoma. J Cancer Therap 2013; 4: 20-23
  • 3 Gloster HM. Free margin distortion. In: Gloster HM, ed. Complications in Cutaneous Surgery. New York: Springer-Verlag; 2008
  • 4 Quatrano NA, Samie FH. Modification of Burow's advancement flap: avoiding the secondary triangle. JAMA Facial Plast Surg 2014; 16 (5) 364-366
  • 5 Donaldson MR, Coldiron BM. Scars after second intention healing. Facial Plast Surg 2012; 28 (5) 497-503
  • 6 Robinson JK, Dillig G. The advantages of delayed nasal full-thickness skin grafting after Mohs micrographic surgery. Dermatol Surg 2002; 28 (9) 845-851