Wedge Shaped Defects

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Wedge-shaped midline defects that are based on the glabella (Fig. 4.2a) or frontal hairline (Fig. 4.2b) can be closed primarily by making an incision above the eyebrow or along the hairline and mobilizing the forehead skin.

Clinical Facial Plastic Images

Fig. 4.2a Wedge-shaped defect in the forehead with an inferior base. An incision is made above the browline, and Burow's triangles are excised just lateral to the brow (see Fig. 4.3). The forehead skin is mobilized in the direction of the arrows. A Z-plasty (red line) can be used to disperse the scar. b For a superiorly based defect, an incision is made approximately 1-1.5 cm behind the hairline. Lateral Burow's triangles are excised.

Fig. 4.2a Wedge-shaped defect in the forehead with an inferior base. An incision is made above the browline, and Burow's triangles are excised just lateral to the brow (see Fig. 4.3). The forehead skin is mobilized in the direction of the arrows. A Z-plasty (red line) can be used to disperse the scar. b For a superiorly based defect, an incision is made approximately 1-1.5 cm behind the hairline. Lateral Burow's triangles are excised.

Fig. 4.3 H-flap (bilateral U-ad-vancement flaps). a For a midline forehead defect over 4 cm wide, an incision is made above the eyebrow and below the hairline. Lateral Burow's triangles are excised on the hairline and just behind the eyebrow to avoid cutting the frontal branch of the superficial temporal artery. The midline scar can be dispersed with a Z-plasty (red line). b All defects are closed.

Wedge Shaped Defect

Fig. 4.3 H-flap (bilateral U-ad-vancement flaps). a For a midline forehead defect over 4 cm wide, an incision is made above the eyebrow and below the hairline. Lateral Burow's triangles are excised on the hairline and just behind the eyebrow to avoid cutting the frontal branch of the superficial temporal artery. The midline scar can be dispersed with a Z-plasty (red line). b All defects are closed.

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