The Periglabellar Flap for Closure of Central Forehead Defects

Abstract

Central forehead defects are difficult for the plastic surgeon. Constraints include tissue match, hair-bearing scalp, proximity of eyelids and eyebrows, and a cosmetically prominent location. Tissue expansion requires multiple operations and weeks of expansion. Local flaps result in added scars to the cosmetically sensitive forehead region. However, the forehead also provides consistent patterns of rhytides that can be used to camouflage local flap scars. This article describes a local flap for reconstructing central forehead skin defects that achieves tissue coverage with a cosmetically appealing result. Six patients with central forehead cutaneous malignancies were reviewed; their defects were too large to close primarily. The defects were closed using bilateral periglabellar local advancement flaps with Burow's triangles, with scars in the natural skin creases of the aging forehead. The superior triangles were oriented horizontally, which placed incisions within the frontalis muscle forehead creases. The inferior triangles were oriented obliquely within skin creases of the corrugator muscles. Central vertical incisions remained and blended inconspicuously into the aging forehead. Five patients with central forehead melanomas and one patient with Mohs' defects after excision of basal cell carcinoma were referred by their dermatologists (age range, 60 to 83 years; mean, 72 years). Defects ranged from 2.1 to 5.3 cm in greatest diameter (mean, 3.7 cm). All were closed with the periglabellar flap. One minor complication of hematoma was treated with aspiration in the office. All six patients were satisfied with the results of their reconstruction. For central forehead skin defects up to 5 cm in diameter, the periglabellar flap offers a reconstructive option that uses local tissue and hides scars within natural forehead wrinkles, providing an aesthetically pleasing result.