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Banal Plastic Surgery

How to Minimize Scarring in Forehead Reduction

To reduce scarring,
tension must be minimized.

The main reason scars widen after forehead reduction
is the tension applied to the incision area.
In other words, the stronger the scalp pulls backward,
the higher the chance the scar will widen.

To reduce tension,
from diagnosis to closure,
there are many factors to consider.

Diagnosis

You must accurately assess scalp characteristics to estimate how many centimeters can be reduced.

If scalp elasticity is not properly evaluated,
the result may differ from expectations.

The forehead may not be reduced as much as expected,
and excessive tension can widen the scar,
or cause shock loss in the frontal area.

Understanding the characteristics of the scalp
through proper experience
is the first step toward successful forehead reduction.

Design

Simply reducing the forehead
is not enough,
you must design in consideration
of the final hairline.

Whether hair transplantation will be needed afterward,
how much baby hair to preserve,
how to hide the scar between existing hair,
and considering hair direction and thickness,
the incision line is designed.

Incision

A scar will remain.
What matters is how well it is concealed.

Because the scar remains as a thin line,
it is not very noticeable,
but using existing hair and baby hair,
it can be hidden even better.

It is important to consider existing hair and
baby hair when positioning the incision line.

Galea Release

Galea release
is the key to forehead reduction.

It involves
making interval incisions in the firm galea
to allow the scalp to stretch sufficiently.

Compared to simple forehead reduction without galea release,
it can reduce the forehead height by more than 1 cm.

However, performing a proper galeotomy is technically challenging,
due to abundance of blood vessels and hair follicles just above the galea.

Only when performed at sufficient depth
can the desired reduction be achieved.

Fixation

Endotine seems
to have no real
disadvantages except cost.

To prevent regression of the advanced scalp,
it must be firmly fixed to the bone.

This can be done using an Endotine device,
or with sutures.

Endotine allows the scalp to be maximally lifted and secured,
and provides stronger fixation,
so we prefer this method.

When mini Endotine is used,
rarely palpable from the surface.

Closure

Skin closure
is only a finishing step,

as the deeper layers are already fully connected.

After subcutaneous closure,
even before the skin is closed,
the skin edges are already well approximated.

There is no tension on the skin.

Now, all that remains
is to align the skin edges neatly.

Both external and internal scars
must be minimized.

When tension is removed in this way,
most scars remain as fine lines.

Visible scars matter, but internal scarring must also be minimized.
This makes future hair transplantation easier.
because the size and amount of scar tissue affect graft survival.