Quoted source text: "Lowering it, and keeping that position."
It should have been finished in one operation.
During revision consultations, we often see patients who had forehead reduction but did not achieve as much reduction as expected, or whose hairline that had initially lowered has risen again. When we inspect the previous surgical site during revision, sometimes the reason becomes apparent.
Reasons for insufficient lowering: galea incision
To lower the hairline significantly in forehead reduction, simply pulling the skin and scalp has limits. The process of appropriately incising and relaxing the galea so the scalp can move forward sufficiently is important. During revision surgery we sometimes find that this process was not performed adequately. Even though there was room to move the scalp further, it was closed without sufficient advancement.
The patient has gone through the burden of surgery once, yet did not fully receive the expected result.
Reasons for re-elevation: fixation
Fixation that keeps the lowered scalp in place is as important as adequately lowering it. Some patients report that the hairline was clearly lowered immediately after surgery but rose again over time. In some cases the line rose because the scar widened. When we inspect during revision, we sometimes find inadequate fixation, and occasionally we cannot find traces that fixation was performed in the previous surgery.
Lowering the hairline to the desired position is not the entire operation. Lowering it and keeping it there—both are important in forehead reduction. We consider both to be essential.
I don't want forehead reduction again.
Some patients develop distrust of forehead reduction from one experience, and even when their facial proportions or current condition suggest forehead reduction would be appropriate, they refuse further surgery and request hair transplantation only. We fully understand that sentiment. Therefore, we do not view revision surgery as simply lowering the forehead a few more centimeters.
This time the same problem should not recur. We check the remaining scalp laxity, dissect and relax the galea sufficiently as needed, and fix the lowered scalp securely so it does not re-elevate. Because we are operating on tissue that has already been operated on, revision can be more challenging than the first surgery. Nevertheless, forehead reduction revision is one of the procedures we are confident performing.
Lower it enough, maintain that position well, and consider the remaining scar when re-operating. If you were disappointed with your first forehead reduction, I hope the second surgery makes you feel, 'So this is what forehead reduction was supposed to be.'
Bleeding, infection, widened scar, sensory reduction, asymmetry, concomitant hair loss, less reduction than expected, or re-elevation may occur. Whether surgery is possible and the extent of reduction are determined after examination.