Forehead and Temple

The forehead and temple possess many characteristics similar to the scalp, though the reconstruction can often be quite different. The frontalis muscle is enveloped by the galea aponeurotica, though the mobility is greater than that of the scalp. The frontalis ends laterally at the temple and is replaced by fascia. The temporal branch of the facial nerve courses under the thin fascia, and therefore is particularly vulnerable with no overlying muscle to protect the nerve. Most small forehead defects should be repaired in the horizontal direction parallel to the forehead creases. This becomes more difficult to accomplish as defects become larger, as there is more tension and eyebrow elevation. Smaller defects can be closed undermining in the subcutaneous fat, where there is less risk of nerve injury and greater tissue mobility. With larger defects, wide undermining in this plane becomes more difficult because the skin is quite adherent to the underlying frontalis muscle. The frontalis muscle fibers run in vertical direction; therefore, one must be careful not to tear through the muscle when reapproximating in a horizontal direction. Larger defects are closed in the vertical direction with the tension vector aligned horizontally and undermined in the avascular subfrontalis plane. Because of the laxity, vertical scars heal very well with minimal spread.