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My experience with forehead reduction surgery

My experience with forehead reduction surgery

I am Dr Ralph ABBOU, plastic surgeon in Paris specializing in facial aesthetic and reconstructive surgery.

Over the past ten years, I have had the opportunity to perform a large number of forehead reduction surgery also know as hairline lowering.

Surgical forehead reduction is a very specialized cosmetic and reconstructive facial surgery procedure. Very few surgeons perform this procedure in the world because it is a technically difficult procedure, little or not taught in hospitals.

Here I will share with you my experience with this surgical procedure.

1) How it all began

When I started my practice, I had never performed this procedure and had only vaguely heard about it. I had never taken a course or been able to witness a forehead reduction surgery in the operating room.

A few years later, a patient came to consult me because she had a large forehead which made her extremely self-conscious.

She had received a hair transplant a few years previously on the top of her forehead but was not satisfied with it at all due to the low density of the hair obtained by hair transplant.

She was so desperate by the result of the hair transplant that she had all the grafts removed by laser hair removal so when I saw her for the first time in consultation she told me: “today I find myself with my big initial forehead with all these scars from the hair transplant, help me doctor, I can’t stay like this I can’t stand myself”

This consultation had a huge impact on me for two reasons:

the first, I didn’t think that patients could be so self-conscious about the size of their forehead.
The second, I had no idea what to do to help this patient.

I simply told the patient that I was sorry and that I had no solution to offer her.

Everything could have ended there but the patient said to me as she left: “please doctor help me, I know you can find a solution”

I apologized once again, explaining to him that unfortunately I was not an inventor and that I could not embark on an unknown intervention.

From that moment on, the patient called my secretary every week saying: so is it good? Has the doctor found the solution?

One evening, this subject tormented me and I began my research by creating a bibliography of medical publications relating to it and videos of the procedure.
Some time later, I went abroad to observe colleagues who practiced it until I was ready to practice it myself.

So when the patient came back to see me in consultation to insist once again, I agreed to perform surgical reduction of the forehead for the first time.

At that moment, I thought I was doing a service to a desperate patient, doing a good deed and putting this procedure in the closet.

Destiny wanted it otherwise…because patients change us

2) Forehead reduction surgery : a useful and powerful intervention

Very far from being futile, contrary to what I read in the press a few months ago, surgical reduction of the forehead is an intervention which allows rapid and spectacular results provided that the therapeutic indications are well understood and well of course to master the surgical technique.

a) Plastic surgery

For purely aesthetic requests, this involves reducing the height of the forehead in order to balance the proportions of the face and to treat a receding, rounded forehead or a receding hairline. Patients are generally very self-conscious and never comb their hair back.
They very often present for consultation with a cap, hat, wig or headband to hide their forehead.

b) Reconstructive surgery

In facial reconstructive surgery, surgical reduction of the forehead makes it possible to treat a large number of loss of substance of the forehead secondary to trauma, burns or cancers of the upper third of the face. The results obtained are very satisfactory because this intervention often allows reconstruction in a single operating stage with immediate results.

c) Facial feminization surgery

In feminization surgery, surgical reduction of the forehead occupies a central place because it makes it possible to feminize the implantation of the hair and to reshape the facial bones for transgender patients.

3) Patients who come from all over the world

As I practice forehead reduction surgery, more and more patients come to consult me and often travel several thousand kilometers. I am honored by this recognition and the satisfaction that patients experience reassures me of the importance and usefulness of this surgical procedure.

I will always remember this patient who came from New Caledonia and who had not left her home for two years because she could no longer stand being looked at by others. Today she has reconciled with herself.

I will also always remember this 18 year old young man from Cameroon who never took off his cap and who was often excluded from class….

4) Innovation and research

I didn’t invent anything. You have to be humble. Surgery is a difficult art that requires constant questioning and a desire to do better each time.

As my interventions progressed, I improved the surgical technique of surgical reduction of the forehead by protocolizing and optimizing all the stages of the intervention.

So, here are my main innovations:

Infiltration of the surgical area is limited to the area of skin which is incised and then resected. It is unnecessary to infiltrate the entire scalp due to the risk of postoperative sequelae alopecia.

I have developed and developed 3 surgical instruments that I am in the process of patenting. These instruments allow me to carry out my entire surgical separation with the shortest possible scar and with as little trauma to the scalp as possible.

I improved the incision outline and suturing technique. These are two fundamental points to minimize the scarring of the procedure. Indeed, the route of the incision must follow the natural layout of the patient’s hair to reproduce the most natural effect possible.

5) Teaching

Several medical articles are being published and I happily welcome colleagues to the operating room who wish to come and learn how to perform this procedure.

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