Forehead Contour Research Articles

Sinocutaneous Fistula: A Long-term Complication After Surgical Feminization of the Forehead.

Facial feminization surgery is part of the process of treating patients with gender dysphoria. Forehead contouring, a common part of facial feminization surgery, modifies masculine facial features of the upper third, especially decreasing the thickness of their frontal sinuses and the orbital bossing. Forehead contouring is considered a safe procedure with minor complications and high patient satisfaction. However, rare cases of sinocutaneous fistula have been reported as long-term complications. The diagnosis and therapeutic management of this complication are challenging. Therefore, the authors report a case of frontal sinocutaneous fistula occurring 2 years and 10 months after forehead contouring with its clinical presentation and treatment modalities. Surgeons practicing forehead contouring and patients undergoing this procedure should be aware of the risk of sinocutaneous fistula, a rare but severe complication that requires multidisciplinary medico-surgical care.

Fat Grafting for Forehead Contouring in Facial Feminization.

For gender-diverse individuals assigned male at birth, postpubertal estrogen and testosterone-lowering therapies alone are often inadequate to reverse the testosterone-related facial characteristics projecting a male sex identity. Facial feminization surgery significantly improves quality-of-life outcomes for gender-diverse patients by relieving this gender incongruence of the face. Because the shape of the forehead is so radically different between men and women, feminization of this area is critical for many individuals. Several techniques are typically used in combination, including hairline advancement, browlift, burring of the supraorbital rims, frontal bone contouring, and anterior table setback. This report describes the use of fat grafting as an adjuvant technique to forehead contouring as means to avoid frontal bone osteotomy, which carries a higher complication profile and often requires hardware placement.

Mapping High-Risk Arteries Using Doppler Ultrasound for Forehead Contouring in Korean Patients.

Forehead flatness is common in Korean populations, and one of the most straightforward techniques for adding volume and achieving a concave forehead is injecting hyaluronic acid (HA) filler. However, definitive guidelines for this procedure are lacking, and careful attention to the arterial anatomy is required to avoid vascular complications. The authors aimed to establish guidelines for performing forehead augmentation using Doppler ultrasound to identify vasculature before HA injection. Arterial mapping of the faces of 34 patients was performed using Doppler ultrasound. Each anatomic layer (skin, subcutaneous fat, and galea aponeurotica) of the forehead with blood vessels was identified. An average volume of 2.85 mL of HA filler was injected. Postoperative complications, such as infection, hematoma, bruising, nodules, skin necrosis, and blindness, were evaluated. Using Doppler ultrasound, the authors successfully traced all 3 blood vessels (supraorbital, supratrochlear, and frontal branch of the superficial temporal arteries) and avoided them during HA injection. None of the patients experienced arterial complications. Doppler ultrasound proves to be an effective technique for arterial mapping, enabling the identification and avoidance of the major blood vessels of the forehead before HA filler injection.

Use of Titanium Mesh During Frontal Sinus Setback in Facial Feminization Surgery: Clinical Outcomes and Perspectives.

Brow position, hairline shape, and forehead projection may confer cis-feminine identity, and facial feminization surgery (FFS) can improve gender dysphoria among transfeminine patients. Depending on the Ousterhout classification, burring, osteotomy, anterior frontal sinus setback, and augmentation, with subsequent fixation via metal or bioabsorbable plates, can address forehead projection. However, titanium mesh, often used in frontal sinus fracture repair, has not been described for forehead contouring in FFS. The purpose of this study was to study clinical outcomes associated with the use of titanium mesh for the stabilization of bone following anterior frontal sinus setback. A retrospective cohort study of trans-female and nonbinary patients undergoing primary FFS by our senior author between January 2021 and February 2023 was performed. Variables collected include demographics, Ousterhout classification, operative details, complications, and follow-up duration. Patients with prior FFS or facial trauma were excluded. Data were analyzed using SPSS, (IBM, Armonk, NY). Forty-three transfeminine patients were included for analysis. The cohort had an average age of 33.0±8.7 years and a median follow-up time of 3.0 months (IQR = 1.0-7.0). Among our cohort, 26 patients (60.5%) received titanium mesh and 17 patients (39.5%) underwent burring only for forehead contouring. There were no reported complications (ie, infection, hardware extrusion, or mucocele formation) or a need for forehead revisions among the entire cohort regardless of the frontal sinus reconstruction material utilized. Clinical outcomes were favorable among patients receiving titanium mesh anterior table fixation during FFS. Titanium mesh can be considered as an additional technique for frontal bossing reduction and anterior table fixation in FFS.

Facial Fat Graft Injection Reduces Asymmetry and Improves Forehead Contour in Early Infancy Apert Syndrome Patients.

The objective of this study is to report the outcomes of a modified comprehensive Apert syndrome surgical protocol in which fat injection was performed during early infancy concurrent with postposterior vault distraction osteogenesis (PVDO) distractor removal. A retrospective study was performed on 40 consecutive young patients with Apert syndrome who underwent PVDO and subsequent distractor removal between 2012 and 2022. Of these 40 patients, 12 patients underwent facial fat injection concurrent with distractor removal to treat residual supraorbital bar recession as part of a modified comprehensive Apert syndrome surgical protocol. Preoperative and postoperative severity of recession and irregularity was graded from 1 to 3, with 1 being less severe and 3 being the most severe. Recession severity was correlated with the number and type of suture fusion. The complication rate was stratified via a Clavien-Dindo scale. The average patient age was 14.3±5 months, with 5 males (41.6%) and 7 females (48.3%). The average hospital stay was 1.08 days. The average volume of free fat graft injection was 8.29±5mL. According to the Likert scale, forehead morphology improved in 91.67% of the patients. Complete resolution of supraorbital bar recession was achieved in seven patients (58.33%), all of whom presenting a single suture synostosis. One patient with a cloverleaf skull presented a type IIIB complication. Facial fat grafting markedly reduces forehead asymmetry and improves forehead contour in Apert syndrome patients following PVDO. Total resolution of forehead recession directly correlated with a single suture fusion.

Aesthetic Removal of Foreign Body Granulomas of Forehead Via Pretrichial Approach.

In the field of plastic surgery, various filler types have been developed, which are widely used for cosmetic or reconstruction purposes. However, unregulated substances often injected by unlicensed practitioners may cause difficult-to-treat side effects, such as foreign body granulomas. Since the forehead is an exposed area and the lesions are likely extensive, complete surgical removal with inconspicuous scar can be difficult. In addition, pharmacological treatments, such as steroids, have only a temporary effect. The authors report successful cases of foreign body removal combined with subcutaneous forehead lift via a pretrichial approach for cosmetic satisfaction.Ten patients who had received illegal filler injections that resulted in chronic granulomas on the forehead were studied. The granulomas were confirmed using sonography, and simultaneous foreign body removal and subcutaneous forehead lifts using pretrichial incisions were planned. For the surgical method, the forehead flap was carefully elevated to a uniform thickness in the subcutaneous plane via a pretrichial incision, and the foreign body was removed, paying attention to the forehead contour and nerve damage; excess skin was excised from the top of the flap to tighten the remaining skin on the forehead.None of the patients developed complications, such as skin necrosis, infection, hematoma, or wound dehiscence, during the follow-up period. The functional and aesthetic outcomes were satisfactory in all the patients.The subcutaneous forehead lift via a pretrichial incision seems to facilitate foreign body removal and improve the forehead deformity by tightening the remaining skin.

Point of Care Virtual Surgical Planning and Three-Dimensional Printing for Feminizing Foreheadplasty.

Point of Care Virtual Surgical Planning and Three-Dimensional Printing for Feminizing Foreheadplasty.

Obliteration and Contouring of Comminuted Anterior Wall Frontal Sinus Fracture Using Pericranial Flaps.

Summary:One of the common postoperative complications of comminuted fractures of frontal sinus are contour deformity, hardware extrusion, adherence and/or palpability, and skin thinning. We are presenting our novel technique with pericranial flaps to decrease these complications. The study was performed from January 2019 to January 2020, on 40 cases of comminuted fractures of anterior wall of frontal sinus, 28 men and 12 women, with an average age of 41 years. Injury resulted from motor vehicle crashes (n = 25), motorcycle crashes (n = 11), and falling from heights (n = 4). Our novel technique involves the use of two anteriorly based pericranial flaps; one flap is used for obliteration of the frontal sinus and the other is used to overlay the hardware used to restore forehead contouring and to eliminate the possibility of early extrusion or late plates or mesh palpability. Two patients had postoperative minimal disruption of forehead lacerations healed with secondary intention and minimal scarring. Excellent patient compliance without any complaint of mesh palpability. No adherence occurred and no skin thinning. This technique (two anteriorly based pericranial flaps) may be more reliable to obliterate the frontal sinus also overlaying the hardware used to improve forehead contour and decrease the incidence of mesh palpability and skin adherence than using hardware without flap coverage.

Apert Syndrome Outcomes: Comparison of Posterior Vault Distraction Osteogenesis Versus Fronto Orbital Advancement.

Presenting a wide clinical spectrum and large variety of clinical features, successful treatment of Apert syndrome necessitates performance of sequential multiple surgeries before a patient's facial skeleton growth is complete.The objective of this study is to compare forehead contour asymmetry and clinical outcomes between Apert patients who underwent either fronto-orbital advancement (FOA) or posterior vault distraction osteogenesis (PVDO). A retrospective study was performed on consecutive patients with Apert syndrome who underwent either FOA or PVDO between 2007 and 2019, and participated in at least 6 months of follow-up care. Forehead contour asymmetry and surgical outcomes for each of the included patients were verified through medical records, clinical photographs, and interviews with the parents of the patients. The need for additional craniofacial procedures based on the surgical outcomes of each patient was graded from I to IV utilizing the Whitaker outcome classification system. Forehead contour asymmetry for all included patients was rated under the Whitaker grading scale as type II (n = 4) 44.4%, type III (n = 2) 22.2%, and type IV (n = 3) 33.3% for FOA, and type I (n = 5) 35.7%, type II (n = 7) 50%, and type III (n = 2) 14.3%, for PVDO (P < 0.05). The average transfused blood volume was 47.77 ± 9.42 mL/kg for patients who underwent FOA, and 22.75 ± 10.31 mL/kg for patients who underwent PVDO (P < 0.05). Patients who underwent PVDO had lower forehead contour asymmetry as per the Whitaker outcome grading scale than patients who underwent FOA.

Forehead Contouring as an Adjunct to Rhinoplasty: Evaluation of the Effect on Facial Appearance, Personal Traits and Patient Satisfaction.

The nose has a great impact on facial beauty and appearance. Therefore rhinoplasty is one of the most performed procedures worldwide. However, considering the varying degrees of cosmetic operations holistic approach to face is essential to achieve more successful results. In order to this, the forehead is noteworthy with its gender-related features and important relation to the nose. The purpose of this study is to assess the effect of forehead contouring with fat grafting adjunct to rhinoplasty on personal traits, facial appearance and patient satisfaction. A total of 15 patients who underwent rhinoplasty and forehead contouring with fat grafting were enrolled in this retrospective study. Facial appearance and personal traits were evaluated via subject Global Aesthetic Improvement Scale (S-GAIS), and patient satisfaction was assessed with custom design Forehead Rhinoplasty Outcome Evaluation Questionnaire (F/ROE-Q). Forehead inclination was calculated as an objective indicator of fat graft survival and contour improvement. Pre- and postoperative photographs were taken and used for evaluation. According to the F/ROE-Q score, mean total preoperative score was 9,13 and the mean total postoperative score was 24,86 (p < 0,01). High postoperative satisfaction scores were observed in all patients. Statistically significant improvement was observed in attractiveness, femininity, youthfulness, facial harmony, forehead contour, facial profile view parameters based on S-GAIS assessment. The mean forehead inclination angle was 19,04o preoperatively and 16,74° postoperatively. With the important benefits such as higher patient satisfaction and improvement on facial appearance and personal traits, forehead contouring with fat grafting was an efficient and applicable procedure adjunct to rhinoplasty. 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 .

Clinical Evaluation and Management Outcomes of Isolated Anterior Wall Frontal Sinus Fractures Fixation with Low Profile Miniplates

Background: Frontal sinus fractures are relatively commonwith high-velocity injury trauma. Isolated anterior wall fracturesrepresent one third of all cases. The main goals offixation are to restore the premorbid aesthetic condition andto preserve a safe and functional sinus. The ideal platingsystem used for fixation of the anterior frontal wall fracturesis the micro plating system owing to its many advantages.However, it is also feasible to utilize the low-profile miniplatingsystem as it has the same advantages.Patients and Methods: A prospective study conducted onpatients admitted to trauma unit in two departments (Maxillofacialdepartment; Assiut University Hospital and PlasticSurgery Department; Qena University Hospital) from August2017 to July 2019 (two years’ duration). The study includedall patients with anterior wall fracture of frontal sinus thatneeded open reduction and internal fixation (ORIF) with sinuspreservation. Materials used: Low profile miniplate system;KLS Martin compact system; 1.5mm craniofacial plates withthickness 0.7mm, miniscrew 1.5mm with 5mm in length anddrill bit 1.1mm diameter. Statistical analysis: Data was analyzedusing the Statistical Package for Social Sciences (SPSS)version 22. p-value <0.05 was considered significant.Results: Follow-up period ranged from 6-12 months.Clinical data revealed that none of the patients complainedfrom these miniplates concerning its palpability under theskin, sensitivity to temperature changes. No plate exposureor extrusion recorded. Only two patients had wound infectionsthat resolved by antibiotic therapy. Patients complained onlyfrom minor symptoms such as pain, supraorbital paresthesiaand facial edema. CT imaging showed good fracture healing,good alignment of the anterior wall and no plate failure(fracture). Patients were satisfied with restoration of theforehead contour and excellent aesthetic results.Conclusion: Isolated anterior wall frontal sinus fracturesare common due to high incidence rate of motor car accidentsin our country. Main lines of treatment aimed to restore a safefunctional sinus, prevent forehead contour deformity andobtain good aesthetic results. These goals can be obtained byfracture fixation with this low profile miniplate system withresultant patient satisfaction.

Dual Purpose of De-Epithelialized Latissimus Dorsi Musculocutaneous Flap for Treatment of Chronic Frontal Sinusitis and Frontal Bone Defect.

Treating frontal sinusitis refractory to endoscopic sinus surgery and complicating frontal bone defect remains a challenge. One surgical option determined is free flap transfer, which has the versatility to accommodate adequate sinus obliteration and reconstruct skin and bone defects. After successful free flap transfer, forehead recessus deformity can emerge as an esthetic problem for patients waiting for cranioplasty. Hence, the authors examine three cases in which they performed free latissimus dorsi musculocutaneous (LDM) flaps for chronic frontal sinusitis with frontal bone defect. All LDM flaps survived without complications, and all patients achieved passable forehead contours without cranioplasty and with no occurrence of infection. In our procedure, the muscle portion of the LDM flap was used to obliterate the frontal sinus, which is similar to conventional free LDM flap. Conversely, our procedure also uses the de-epithelialized skin paddle of the LDM flap filled with the frontal bone defect, which is distinct from conventional free LDM flap. Thus, preventing postoperative forehead recessus deformity has been the identified as primary advantage of our procedure. The use of the free de-epithelialized LDM flap transfer fulfills two goals: controlling chronic frontal sinusitis and restoring a passable forehead contour.

Facial Feminization Surgery: A Review of 220 Consecutive Patients.

Background Facial feminization surgery (FFS) is a combination of facial bony and soft tissue surgeries designed to modify and convert a masculine face to feminine. One’s face plays a very central role in gender incongruence and FFS helps patients overcome this. There are prominent differences between the male and the female facial anatomy (bony and soft tissue) which can be surgically altered to change the visual perception of the face. Methods The author presents the method used at his center for treating 220 patients of gender incongruence requesting FFS from June 2016 to June 2019. The alterations to known methods of forehead contouring, hairline lowering, and jaw shave adopted by his team are discussed. He also presents the logic of performing the entire FFS in two stages at an interval of 7 to 10 days. Results A total of 220 cases of FFS are presented, along with surgical details of techniques used, the sequence and staging of procedures performed, and the results obtained. A two-staged approach to FFS is proposed to maximize the recovery and minimize complications and promote faster healing. Different methods of forehead contouring are also explained in detail. Conclusions FFS is a very rewarding surgery for the plastic surgeon and has high patient satisfaction rate. With proper training in craniomaxillofacial and soft tissue surgery, it is possible for the plastic surgeon to be the main team leader for this procedure. A two-stage approach is highly recommended.

Forehead Fat Grafting: Asian Facial Contouring and Augmentation.

Aesthetic facial contouring procedures, particularly forehead augmentation, continue to increase in popularity in the Asian population. However, there are very few reports in the literature specifically examining the long-term outcomes of forehead fat grafting. In the present study, the authors aimed to objectively evaluate the efficacy of autologous forehead fat grafting through evaluation of facial proportions and patient-reported outcomes. Patients who underwent autologous fat grafting for forehead contouring procedures between July of 2011 and June of 2017 were recruited for participation in the study. Patient demographic and clinical variables were collected preoperatively and postoperatively. Facial proportion analysis was collected and compared from preoperative and postoperative photographs. Satisfaction with outcome was assessed by the patient, the surgeon, and a layperson postoperatively. A related-samples Wilcoxon signed rank test was used for statistical analysis. Postoperative outcomes were evaluated in a total of 24 patients who underwent forehead autologous fat-grafting procedures. The average postoperative follow-up was 8.1 months. There were no intraoperative or postoperative complications. More than 50 percent of the postoperative results were evaluated as "satisfactory" by all three groups (i.e., patient, surgeon, and layperson) in terms of aesthetic contouring. Average forehead projection increased 0.24 U (ratio of horizontal distance from midforehead plane to cornea plane/cornea diameter) after one round of fat grafting (p = 0.01). Seven patients (29.2 percent) required more than a single round of fat grafting to achieve optimal results. Autologous fat grafting remains a viable option for forehead contouring and augmentation. The findings of this study demonstrate that the operation is effective and offers stable satisfactory results after long-term follow-up. Therapeutic, IV.

S8A-10 SESSION 8A: METOPIC SYNOSTOSIS COMPARISON OF HEAD SHAPE OUTCOMES IN METOPIC SYNOSTOSIS: LIMITED STRIP CRANIECTOMY VERSUS FRONTO-ORBITAL RECONSTRUCTION

Introduction: True metopic craniosynostosis (MCS), with its severely trigonocephalic head shape, is often treated with either limited incision strip craniectomy (LISC) followed by helmet orthotic treatment, or open fronto-orbital reconstructive techniques (FOR). There is controversy regarding resultant shape outcomes among craniofacial surgeons. Those adverse to LISC claim normal head shape is never attained, while proponents believe there is gradual correction to an equivalent outcome. This has become contentious, with anecdotal claims frequently the basis of the opposing arguments. No whole head quantitative 3D outcome studies, with normal controls, have been done to support these arguments. This study aims to address these gaps. Methods: 3D images of 31 patients with MCS, were analyzed retrospectively with a 1:1 cohort of age-matched normals. Head shape analyses were performed at: 1) pre-op; 2) 1 month post-op; 3) 10–14 months post-op; 4) 25–36 months post-op. 3D composite heads of MCS patients at each time point were calculated and compared to normal controls and to each other. 2D standardized cross sections of the forehead were also compared and statistically analyzed. Results: In the LISC group, improvement spread laterally across the forehead over time. Hypotelorism improved as well. By 1 month post-op the flatness of the forehead ridge extended to the medial canthus, by 10–14 months it extended to the orbitale superius, and by 25–36 months, it approached the lateral canthus. In the FOR group, after 1 month the forehead contour was nearly spherical. The height of the cranium increased at 1 year post-op. By 25–36 months, there was some widening of the interorbital distance, but no further change in forehead contour. Comparing the LISC vs. FOR groups using contour color maps, which describe protrusion or retrusion as compared to normal, the contours of the groups were similar, albeit not the same size due to age differences. In the 2D analysis, the total differences between LISC and FOR groups also decreased to a point of similarity over time. Conclusion: Both LISC and FOR techniques achieved a normal head shape, reducing the magnitude of shape differences between each intervention and normal cohorts. The pace of head shape improvement was different between the two techniques, consistent with the intuitive expectation that FOR would normalize more quickly, achieving its best approximation to normal by 1 month post-op. However, LISC achieved a similar equivalence to the normal cohort by 10–14 months post-op. This study supports the assertion that both techniques accomplish the goal of normalizing head shape.

Chest and facial surgery for the transgender patient.

In conjunction with social transition, hormones, and counseling, gender-affirming surgery (GAS) is a key component in the treatment gender dysphoria. Gender affirming surgeries can be divided into genital surgery (phalloplasty, metoidioplasty, oophorectomy, vaginoplasty, and orchiectomy) and non-genital surgeries. The non-genital surgeries for transmasculine individuals include chest masculinization and body contouring. For transfeminine individuals, they include breast augmentation, and facial feminization. Chest masculinization eliminates the need for binding and improves overall confidence and quality of life. Choice of technique depends on body habitus and patient preference. For transfeminine individuals, some breast growth can be achieved with the use of estrogen over the course of 1-2 years, but many still require breast augmentation for breasts that are proportionate to their frame. Facial surgery for transfeminine patients is highly effective in changing classic masculine anatomic features to feminine norms. The most common of these procedures include forehead contouring, rhinoplasty, lip lift, mandible angle reduction, genioplasty and chondrolaryngoplasty. These non-genital surgeries are critical to treating gender dysphoria in transgender and gender non-binary individuals. Further research with standardized and validated assessments of patient reported outcomes is needed to fully understand long term effects on quality of life and gender dysphoria.

Forehead biconvexity enhancement with fat grafting

Frontal biconvexity is a key criterion for an attractive forehead. Fat injection as an effective, safe and reliable method for soft tissue augmentation could be used to enhance forehead contour. We report our experience with combined platelet-rich plasma (PRP) and fat grafting to create or restore frontal biconvexity and to reduce wrinkles. Fifty-seven females and 4 males (mean age, 40.2 years) underwent the combined PRP and fat injection. Fat mixed with PRP on the ratio of 5:1 was injected in small aliquots in the space between the dermis and underlying frontalis muscle. Patient satisfaction with the cosmetic result was evaluated by a questionnaire using pre- and postoperative photos and a four-point grading scale. All patients who underwent three injection sessions (n = 5) evaluated the esthetic result as excellent. In patients who had two injection sessions (n = 36), 36% evaluated the result as excellent, 50% as good, and the remaining 5 as moderate. In patients who had a single injection session (n = 15), 27% evaluated the result as excellent, 40% as good, and the remaining 5 as moderate. Concerning frontal wrinkles, 25 of 34 (73.5%) patients reported good improvement and the remaining 9 (26.5%) reported moderate improvement. Fat injection combined with PRP should be considered as an effective tool to improve forehead biconvexity. Level of evidence: Level IV, therapeutic study.

Aesthetic Durable Forehead Contouring in Asians With Fat Grafting and Botulinum Toxin.

Augmentative forehead contouring to create a full rounded smooth forehead is increasingly popular worldwide especially in East Asia where a flat and/or concave irregular forehead is considered unaesthetic. We present our outcomes performing fat transfer to the forehead in combination with botulinum toxin (Botox) corrugator-frontalis injection where indicated in East Asians. From 2013 to 2017, 62 consecutive patients with flat and/or concave irregular unaesthetic foreheads underwent forehead fat transfer using a microautologous fat transplantation gun. Concomitant Botox injection to minimize corrugator and frontalis contraction-mediated fat displacement was indicated in 23 patients (thin forehead skin and/or excessive forehead animation or rhytides) to prevent forehead vertical crease formation. Thirty-nine subjects with a mean follow-up of 16 months (range = 3-44 months) had their pregraft and postgraft forehead contours assessed on an aesthetic grading scale. Of these 39, 17 completed forehead fat graft volumetric analysis using preoperative and postoperative 3D photography. Aesthetic results were durable at latest follow-up, and all patients were satisfied with their final appearance. The mean amount of fat transferred was 7.72 mL (range = 1.5-33 mL). One subject required a repeat fat grafting (with Botox) because of vertical crease formation after the index procedure (without Botox). Another 12 needed a second fat-grafting session to optimize the contour. All who received Botox did not develop vertical creases. The mean ± SD forehead contour grade improved from 2.29 ± 0.77 to 3.24 ± 0.67 (P < 0.001). The percentage mean ± SD retention of grafted fat was 46.71% ± 5.77% with Botox versus 39.12% ± 5.24% without Botox (P = 0.006). Fat grafting to the forehead using our technique with selective Botox administration is an effective, simple, fast, inexpensive, and safe strategy for aesthetic forehead contouring especially for flat and/or concave foreheads. Forehead fat survival rate is objectively improved with simultaneous Botox injection. There is minimum downtime and long-lasting results with high patient satisfaction rates.

Restoration of the Fronto-Orbital Buttress with Primary Bone Fragments.

ObjectiveForehead deformities are often caused by lack of treatment or incorrect restoration of the frontal buttress, so the underlying frontal buttress should be restored to its previous position to ensure that the previous forehead contour is restored in cases of complex depressed skull fractures. However, since brain injuries from skull fractures could have fatal consequences, the clinical concern in primary surgery has been to save the patient's life, and cosmetic concerns have always been secondary. We retrospectively reviewed fronto-orbital fracture patients who underwent primary restoration with primary bone fragments or an alloplastic implant and compared the surgical outcomes of autologous bone (group 1) and artificial materials (group 2).MethodsA retrospective review was conducted of 47 patients with fronto-orbital fractures between March 2012 and January 2018. The patients underwent primary reconstruction with primary bone fragments or an alloplastic implant. The surgical results were evaluated by the incidence of infection and cosmetic satisfaction of patients.ResultsInfections occurred in one patient (5%) in group 1 and in two patients (15.3%) in group 2, which was not a statistically significant difference. In contrast, at 6 months after surgery, patient satisfaction showed a statistically significant between-group difference (group 1: 4.32 points, group 2: 3.54 points, p=0.001).ConclusionPrimary reconstruction using fractured bone fragments is an effective and preferable method that could result in better surgical outcomes than restoration using an alloplastic implant.

The Supratarsal Approach for Correction of Anterior Frontal Bone Fractures.

To approach isolated anterior frontal bone fracture, coronal incision is the common surgical access of choice. This approach has complications such as aesthetically undesirable scarring and alopecia along the incision line. An alternative approach to these fractures is through a supratarsal incision. The aim of the present study was to correct the frontal bone fracture, through supratarsal approach. Six consecutive patients with frontal bone fracture were operated through supratarsal incision and evaluated regarding: patient cosmetic satisfaction, forehead contour, scarring, sensibility and motility in forehead and upper eyelids. Seven months (6-12) postoperatively, all the patients had normal mobility in the forehead and the upper eyelids and 17% (n = 1) had hypoesthesia of superior orbital nerve. The forehead contour was excellent in all patients. About 83% (n = 5) of the patients were very satisfied and 17% (n = 1) were satisfied with the surgical result. Correction of anterior frontal bone fracture through a supratarsal approach appears to be safe and offers a sufficient exposure to the frontal bone fracture correction with excellent contouring results and no noticeable scarring.