Lateral Forehead Research Articles

Lateral forehead flap in oral reconstruction: A case report

Introduction: Lateral Forehead flap is very versatile as it represents a good choice for reparation of different types of nose and oral cavity defects and provides an optimal, aesthetic, and functional outcome. In era of free transfer tissue, the use of loco-regional flaps, alone or in combination may prove to be the only practical solution in the absence of resources or other options. Case presentation: A-65 years old male with multiple comorbidities underwent a wide resection with adequate margin of the lower lip and small segment of the upper lip due to a locally advanced squamous carcinoma. After long consideration, the last resort was the pedicled lateral forehead flap. Information was sourced from patient’s case notes and operating theatre report. Results: The donor defect was covered with a split-thickness skin graft harvested from the right thigh area. The flap survived and both functional and aesthetic outcome were satisfactory. The site of the donor defect result was also acceptable. No complications were noted in our case study beside a small tip necrosis and breakdown of the suture line. Conclusion: Lateral forehead flap is a reliable flap with an acceptable outcome in cases with previous history of radiotherapy or surgery. Decision making of a particular reconstructive option should be done taking in consideration the available resources, surgical team expertise along with the patient's general condition. The pedicled forehead flap still useful when other options are inappropriate or have not been successful.

Optimal facial regions for remote heart rate measurement during physical and cognitive activities

Remote photoplethysmography (rPPG) has gained prominence as a non-contact and real-time technology for heart rate monitoring. A critical factor in rPPG’s accuracy is the selection of regions of interest (ROI), as it can significantly influence prediction outcomes. Most studies typically use the forehead and cheeks as ROIs, but little research has explored other facial regions or how stable these ROIs are during physical movement and cognitive tasks. In this study, we analyzed 28 facial regions based on anatomical definitions using two mixed datasets derived from three public databases: LGI-PPGI, UBFC-rPPG, and UBFC-Phys. We applied rPPG algorithms such as orthogonal matrix image transformation (OMIT), plane-orthogonal-to-skin (POS), chrominance-based (CHROM), and local group invariance (LGI). Our findings show that the glabella, medial forehead, lateral forehead, malars, and upper nasal dorsum consistently perform well, with the glabella achieving the highest overall evaluation score. These results offer valuable insights for advancing remote heart rate monitoring technologies.

Forehead Flap - A Salvage Option for Failed Anterolateral Thigh Flap in Buccal Mucosa Carcinoma Reconstruction

Introduction: Pedicled lateral forehead flap could be a valuable option for reconstruction in the floor of the orbit and floor of the mouth in the absence of other resources available. Case presentation: A-57-year-old male with multiple comorbidities, underwent partial maxillectomy, hemi mandibulectomy and hemiglossectomy with infratemporal fossa clearance due to a rapidly spreading buccal mucosa carcinoma on the left side. The last resort was the pedicled lateral forehead flap after unsuccessful reconstructive attempts with an anterolateral thigh flap. Discussion: The pedicled forehead flap which has rich vascularity, decreased donor site morbidity and reliable anatomy made it a favorable locoregional flap for oral reconstruction. Conclusion: Flaps should be chosen considering the patient’s condition and resources available. Forehead flap due to its proximity is an ideal option for reconstruction of oral cavity defects.

Forehead Flap - A Salvage Option for Failed Anterolateral Thigh Flap in Buccal Mucosa Carcinoma Reconstruction

Introduction: Pedicled lateral forehead flap could be a valuable option for reconstruction in the floor of the orbit and floor of the mouth in the absence of other resources available. Case presentation: A-57-year-old male with multiple comorbidities, underwent partial maxillectomy, hemi mandibulectomy and hemiglossectomy with infratemporal fossa clearance due to a rapidly spreading buccal mucosa carcinoma on the left side. The last resort was the pedicled lateral forehead flap after unsuccessful reconstructive attempts with an anterolateral thigh flap. Discussion: The pedicled forehead flap which has rich vascularity, decreased donor site morbidity and reliable anatomy made it a favorable locoregional flap for oral reconstruction. Conclusion: Flaps should be chosen considering the patient’s condition and resources available. Forehead flap due to its proximity is an ideal option for reconstruction of oral cavity defects.

Estrogen hormone therapy stabilizes lateral hairline in transfeminine patients: Implications for facial feminization surgery

BackgroundAlthough many studies report on the suppressing effects of estrogen therapy on facial and body hair in transgender and nonbinary (TGNB) individuals, few studies have elucidated its effects on hairline stability on the scalp. In this work, we assessed the influence of estrogen therapy on forehead length. MethodsAll TGNB patients assigned male at birth (AMAB) seeking facial feminization surgery aged 30 years or older were included in the study. Central and forehead length were collected at initial consultation visits. Variables that potentially influence hair growth were collected by chart review, including age, duration of hormone replacement therapy (HRT), presence of spironolactone, and presence of other hair treatments, including finasteride, dutasteride, or minoxidil. Multivariable linear regressions were constructed with relevant predictor variables, while also incorporating global health scores as a proxy for psychological effects on hair loss. Results171 patients were included in this study, with a median age of 36.0 [interquartile range (IQR): 32.0-46.0] years and a median HRT duration of 2.0 [1.0-6.0] years. Multivariable linear regressions revealed no significant predictors for central forehead length. On the other hand, lateral forehead length was positively predicted by age (B=0.06, 95% confidence interval (CI) [0.03-0.08], p<0.001) and hair treatment (B=0.66, 95%CI [0.14-1.18], p=0.01), but negatively predicted by HRT duration (B=-0.07, 95%CI [-0.10- -0.04], p<0.001). ConclusionsAlthough older age is a predictor of lateral hairline recession in TGNB AMAB individuals, lateral forehead length was also predicted to decrease by 0.07cm with each year of feminizing hormone therapy in patients over 30 years of age.

Accuracy of a zero-heat-flux thermometer in cardiac surgery, a prospective, multicentre, method comparison study

Accurate measurement of core temperature is of utmost importance during on-pump cardiac surgery, for detection of hypothermia before cardiopulmonary bypass (CPB), guidance of temperature management on CPB, active rewarming on CPB and guidance of warming therapy after CPB. Most temperature measurement methods are known to become inaccurate during rapid changes in core temperature and suffer from delayed detection of temperature changes. Zero-heat-flux temperature (ZHF) measurement from the lateral forehead may be an alternative, non-invasive method quantifying the core temperature. A prospective, observational, multicentre study was conducted in one hundred patients scheduled for on-pump coronary artery bypass grafting. Core temperatures were measured every minute by two zero-heat-flux thermometer (SpotOn™) and a bladder thermometer and a pulmonary artery catheter (PAC) in the period after induction of anesthesia until CPB. Accuracy and precision of both methods were compared against core temperature measured in the pulmonary artery using the method of Bland and Altman. A high accuracy (around 0.1 °C) and a very good precision (Limits of agreement (LoA) − 0.6; 0.4 °C) were found between zero-heat-flux thermometer and core temperature measured by PAC. Among the two ZHF thermometers the bias was negligible (− 0.003 °C) with narrow LoA of − 0.42 °C and 0.41 °C. In contrast, bias between bladder temperature and PAC temperature was large (0.51 °C) with corresponding LoA of − 0.06 °C and 1.1 °C. ZHF thermometers are in contrast to bladder temperature a reliable core temperature monitor in cardiac surgery during the period after induction of anestesia until CPB. The zero-heat-flux method can provide clinicians reliably with continuous and non-invasive measurements of core temperature in normothermic and mild hypothermic temperature ranges and therefore can be helpful to guide temperature management.

Developing a Reproducible Procedure for Optimal Utilization of Platelet‐Rich Plasma (PRP) and Platelet‐Rich Fibrin (PRF) in Aesthetic Treatments: Efficacy Evaluation Using Ultrasound Imaging—A Single‐Center Prospective Open‐Label Randomized Study

Objective. This single‐center, prospective, open‐label randomized study aimed to produce a repeatable procedure for isolating platelet‐rich plasma (PRP), maximizing platelet recovery and concentration parameters from the collected material, and to assess the effectiveness of autologous platelet‐rich plasma (concentrated platelet rich plasma C‐PRP and platelet rich plasma low centrifugation concept PRP LCC) and platelet‐rich fibrin (injectable platelet rich fibrin I‐PRF and fluid platelet rich fibrin F‐PRF) injections on skin density and thickness in facial aesthetic treatments. Methods. Twenty participants aged 30–60 underwent a series of three treatments (intervals: 4–6 weeks). The study encompassed the following two stages: a laboratory and a clinical one. In the first stage, the aim was to optimize centrifugation parameters (time and speed) of whole blood to produce the highest quality product for use in aesthetic treatments. Double centrifugation of blood produced the following four types of plasma fractions with different parameters: platelet‐rich plasma (C‐PRP and PRP LCC) and platelet‐rich fibrin (I‐PRF and F‐PRF) each with two different platelet concentrations (202% in the first centrifugation and 148% in the second centrifugation). The total PLT recovery in the procedure was 76%, with an average of 32% in the first centrifugation and that of 44% in the second one. In the clinical stage, treatments involved C‐PRP, PRP LCC, I‐PRF, and F‐PRF injections in the forehead, lower eyelid, and cheek areas. In ultrasound skin examination with randomly assigned measurements for each patient, a series of acoustic density values directly proportional to tissue density was obtained. Thickness of the skin was also determined (µm) by summation of the epidermis and dermis thickness. Measurements were made in the lateral forehead, lower eyelids, and cheek regions. Results. Statistical analysis elucidates the effectiveness of blood‐derivatives therapy in the introduced regiment. The increase in skin density was statistically significant after the following treatment: three sessions in 4–6 week intervals, each consisting of 1 mL of C‐PRP injections in the forehead area, 1 mL of I‐PRF injections in the lower eyelid area, and 3.5 mL of PRP LCC and 3.5 mL of F‐PRF injections in the cheek area. Furthermore, significant improvements in skin density were recorded in the cheek and forehead areas (F(3, 24) = 4.5170 with p = 0.011971 for cheeks and F(3, 24) = 9.2327 with p = 0.000305 for forehead). Lower eyelid skin density and thickness also increased significantly (F(3, 24) = 3.2653, p = 0.038881). No significant changes were noted in skin thickness in the forehead and cheek areas (F(3, 6) = 1.438771, p = 0.321616 for cheeks; F(3, 6) = 2.383248, p = 0.168172 for forehead). Patient satisfaction was high, as evidenced by a GAIS average score of 2.75. Conclusion. The study confirms the efficacy of C‐PRP, PRP LCC and I‐PRF, and F‐PRF injections in increasing skin density and, to a lesser extent, skin thickness in specific facial areas. As a result of this research, ready‐to‐use kits (PLASMOO) for obtaining PRP and PRF were developed and put into production. These findings underscore the potential of autologous plasma and fibrin formulations in aesthetic medicine, which offer substantial improvements in skin quality and patient satisfaction. This trial is registered with ISRCTN10538865.

Repair of Large Lateral Forehead and Temporal Wound.

Repair of Large Lateral Forehead and Temporal Wound.

Reconstruction of an Eyebrow and Lateral Forehead Defect After Mohs Surgery.

Reconstruction of an Eyebrow and Lateral Forehead Defect After Mohs Surgery.

Ultrasonographic analysis of facial skin thickness in relation to age, site, sex, and body mass index.

Numerous nonsurgical but invasive cosmetic procedures are performed blindly in the dermis or subcutaneous fat layer of the facial skin. To measure the numerical skin thickness of the facial areas where dermatological procedures are performed by applying ultrasound techniques, and to make it possible to estimate the skin thickness by investigating the influence of several individual constitutional factors such as age, sex, and body mass index (BMI), so that these variables can be applied to estimate skin thickness. Skin thickness was measured at eight different facial points using an ultrasound machine (Affiniti 50; Philips Inc.). Demographic data were gathered using questionnaires. Manual BMI was calculated from the weight and height of each participant, and individual BMI measurements were performed using a body composition analyzer. In terms of whole skin thickness, the thickest point was the mouth corner, and the thinnest point was the lateral forehead. The thickest point in the epidermis was the chin, and the thinnest point was the nasolabial fold. The thickest point in the dermis was the corner of the mouth, and the thinnest was the lateral forehead. Full skin thickness and dermal thickness were mostly lower in females. Skin thickness was not significantly correlated with BMI. The skin thickness at different points on the face was variable, and realistic data about skin thickness can be obtained by in vivo ultrasonographic analysis of the skin.

Analysis of Hairline and Forehead Sexual Dimorphic Aesthetics in 60 Celebrities Using Artificial Intelligence.

Thirty white female and 30 white male celebrities were included. Three full-face front-view photographs of each celebrity were evaluated by a facial analysis program, using Vision framework and MATLAB. After converting pixel distances to absolute distances, midline and lateral forehead heights were calculated and compared between men and women. Forehead height was similar between attractive men and women, but forehead width was shorter in women. Analysis of forehead height at various points along the hairline demonstrated that forehead measurements above the lateral brow and brow peak were significantly greater in men. Mean forehead height above the lateral eyebrow was 3.51 cm in women and 4.16 cm in men (P = 0.017). Forehead height above the eyebrow peak was 4.34 cm in women and 5.55 cm in men (P < 0.001). Medial forehead height was similar between men and women, indicating that the greatest difference in attractive male and female foreheads is in the lateral forehead and forehead width. Analysis of attractive white celebrities demonstrated no significant differences in central forehead heights between men and women. Forehead width and lateral forehead height were significantly smaller in women, with an overall downward slanting contour. Male hairlines were more horizontal and slanting upward laterally. These results have implications in facial rejuvenation and facial gender-affirming surgery.

Repair of a Large Lateral Forehead and Temple Defect.

Repair of a Large Lateral Forehead and Temple Defect.

The pedicled lateral forehead flap in reconstructing oral floor defect - The last resort; case report.

Introduction and importanceLocoregional flaps, particularly the pedicled lateral forehead flap, are not usually used in reconstructing oral floor defects following oncologic resection. Rather, microscopic free flaps have evolved to be the standard of care in head and neck reconstruction. However, the pedicled lateral forehead flap could be valuable in floor of the mouth reconstruction in the absence of resources or other options.Case presentationA-56 years old lady with multiple comorbidities who underwent near total glossectomy, bilateral supraomohyoid neck dissection, and right lateral mandibulotomy due to a locally advanced lingual squamous carcinoma. The last resort was the pedicled lateral forehead flap after many unsuccessful reconstructive attempts utilizing the free anterolateral flap, free radial forearm flap, and pedicled pectoralis major flap.Clinical discussionDecreased donor site morbidity and reliable anatomy are among many of the advantages that made free flaps favorable over locoregional pedicled flaps, especially in oral cavity defects coverage. Of the latter, the pedicled forehead flap, rich in vascularity and neighboring the oropharyngeal defects, could be used with different techniques and modifications. Close monitoring and patient condition optimization is required.ConclusionChoosing a particular reconstructive option should be done considering the available resources and expertise and the patient's condition. The pedicled forehead flap remains valuable when other options are inappropriate or have failed.

Repair of a Large Lateral Forehead Defect.

Repair of a Large Lateral Forehead Defect.

Split Lateral Forehead Flap for Reconstruction of Upper and Lower Eyelids

Background: Eyelids reconstruction after tumor resection has be one of the most challenging procedures in reconstructive plastic surgery. Small defects may be closed by primary suture or covered by small local flaps or skin graft. But in large eyelids defects, we need to find a bigger source of color and texture matching tissue that will ensure functional and aesthetical outcomes. Many techniques have been described, but in this case, the author suggest a split lateral forehead flap designed to cover upper and lower eyelids. Patient and Operation Techniques: A Male 51 years-old-patient, presented himself in our clinic with a basal cell carcinoma involving the right upper and lower eyelids. The tumor had a history of 7 years, without any pain or vision disorders involved. Tumor was widely excised, leaving a full thickness on upper and lower eyelids. The inner lining palpebral was replaced by composite auricular graft following by lateral cantophexy. A lateral forehead flap raised with a right temporal pedicle, and the distal part of flap was split in half, and inset into the upper and lower eyelids defect. The donor region was closed with an STSG from Femur Dextra. After 14 days the flap was divided, the functional result was excellent. Discussion: At first, surgeons were worried of raising forehead flaps beyond the midline, fearing that by splitting the distal flap would cause its compropmise. However, rich anastomostic plexus exists between the major forehead angiosomes lined by the smaller calibre “choke” vessels. Conclusions: Periorbital Basal cell carcinoma resection may leave great defect to the underlying tissue. The need to provide adequate support to this structure requires complex techniques with minimum two flaps. In our case, we performed a split lateral forehead flap with a good functional and cosmetic outcome.

English

English

New Surgical Technique: Bidirectional Forehead Narrowing and Eyebrow Lifting Using Regional Flap Mobility.

Background:We describe our experience with bidirectional forehead narrowing and eyebrow lifting (BiNaLi), a surgical technique we have been practicing for several years to correct facial esthetic issues of patients such as long forehead, high hairline, and low eyebrow level, which helps us achieve forehead height reduction with eyebrow lifting, using 1 incision line in a one-stage procedure.Methods:We divided 576 patients who visited our institution between March 2014 and February 2019 into 4 groups: long forehead only (group I), low eyebrow level (groups II and IV), and M-shaped hairline (groups III and IV); BiNaLi operation was performed as appropriate for each group.Results:The preoperative length of the median area of the forehead was 7.3 cm, and the mean postoperative change in the length of the same was 1.4 cm. The lateral forehead length was also measured for groups III and IV. The mean preoperative length was 7.7 cm, and the mean postoperative change in the length was 1.7 cm. Eyelid length was also measured for groups II and IV. The mean preoperative length was 0.7 cm, and the mean postoperative change in the length was 0.3 cm. More than 90% of the patients gave a score of 4.0 or higher for esthetic satisfaction.Conclusions:We designed a BiNaLi technique to satisfy patients’ facial esthetic needs using changes in flap movement direction, adjustment in the range of skin excision, and differences in flap dissection. A single operation can have various effects, including achieving forehead shortening, clear double-fold line through eyebrow lifting, and correction of a mild M-shaped hairline.

Electric scooter craniofacial trauma.

ObjectiveThe use of standing electronic scooters associated with micromobility applications (e‐scooters) has risen nationally. The aim of this study was to obtain a detailed view of soft tissue and bony craniofacial injury associated with e‐scooter‐related trauma.MethodsSingle‐institution retrospective case series of patients presenting to a level 1 trauma center emergency department or trauma unit with documented e‐scooter‐related craniofacial injury.ResultsOf 203 included patients, 188 (92.6%) patients sustained craniofacial injury. One hundred thirty‐one (64.5%) had exclusively soft tissue injury, 3 (1.5%) exclusively bony injury, 51 (25.1%) both soft and bony injuries, and twenty‐five (12.3%) patients sustained dental injury. Aesthetic units most frequently sustaining acute soft tissue injury were the forehead (n = 106, 34.6%), scalp (n = 36, 11.8%), chin (n = 34, 11.1%), upper lip (n = 32, 10.5%), and cheek (n = 31, 10.1%). Aesthetic subunits most often sustaining acute soft tissue injury included the brow (42, 13.7%), central forehead (39, 12.7%), lateral forehead (n = 25, 8.2%), and upper lip vermillion (n = 23, 7.5%). Craniofacial osseous fracture most often occurred in the orbit (n = 42, 24.6%) and maxilla (n = 40, 23.4%). Individual osseous segments most frequently sustaining acute fracture included the anterior maxillary sinus wall (n = 22, 12.9%), nasal bone (n = 20, 11.7%), lateral orbital wall (n = 16, 9.4%), orbital floor (n = 15, 8.8%), and zygomatic bone (13, 7.6%).ConclusionsOur analysis demonstrates that most patients presenting to our center with craniofacial trauma sustained acute bony fracture, most often to the midface. Our data of common injuries associated with e‐scooter trauma could inform implementation in the form of facial safety equipment or safety skills training for e‐scooter riders.Level of evidence4

Face and Neck Pigmentary Alterations in Hair Dye Users: A Cross-sectional Study from South India.

Background:Hair dyes are commonly used for the concealment of grey hair in India. The pigmentary alterations produced by hair dyes on the face and neck have not received sufficient attention.Aims:To study the pigmentary alterations on the face and neck in hair dye users, and identify possible risk factors associated with the face and neck hyperpigmentation.Methods:A hospital-based descriptive cross-sectional study was done on consecutive hair dye users. A detailed history was taken, and a clinical examination was done to record the pigmentary alterations. The patterns, areas affected, the intensity of hyperpigmentation, percentage of the area involved and risk factors were noted.Results:One hundred and twenty patients were included in the study. Around 118 (98.3%) patients had hyperpigmentation over face and/or neck: 16 (13.3%) barely perceivable, 40 (33.3%) mild, 44 (36.7%) moderate, and 18 (15%) severe pigmentation. The lateral forehead (106, 88.3%), the helix of the ear (106, 88.3%), central forehead (97, 80.8%), and zygomatic area (92, 76.7%) were the most frequently affected areas in our study. Fourteen patients (11.7%) had depigmented macules on the scalp and/or lips.Conclusion:Pigmentary alterations, particularly hyperpigmentation over the upper face and ears are common with the use of hair dyes. The skin type may play a role in the intensity of hyperpigmentation.

The utility of the lateral forehead flap in demanding reconstructive situations: our experience in a tertiary care center

The current century is an era of microsurgical reconstruction. However, there are situations when free tissue reconstruction is not possible due to extremes of age, their associated co morbidities and dearth of microsurgical expertise and equipment. The significance of local and regional flaps in such reconstructive scenario is paramount. These flaps are well vascularised, easy to master, quick to perform and can be used in both primary as well as salvage reconstruction. The Lateral forehead flap (LFF) is one such useful option. The LFF is an axial myocutaneous flap spanning the entire forehead aesthetic subunit. Herein we describe the operative technique of LFF elevation, advantages and disadvantages of the use of this flap in the reconstruction of facial and intra oral defects reconstruction, both in primary and salvage settings. We describe our experience in the use of this handy flap for various facial reconstructions in our institute. This versatile “forgotten” flap which is easy to master can be handy to all general plastic surgeons who indulge in such reconstructions.