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Aesthetic Durable Forehead Contouring in Asians With Fat Grafting and Botulinum Toxin

Kang, Gavin Chun-Wui, MD, MEng*; Hsiao, Yen-Chang, MD; Huang, Jung-Ju, MD; Chen, Jyh-Ping, PhD; Chen, Philip Kuo-Ting, MD; Chen, Yu-Ray, MD; Chang, Chun-Shin, MD, MS†‡

doi: 10.1097/SAP.0000000000001704
Aesthetic Surgery
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Background Augmentative forehead contouring to create a full rounded smooth forehead is increasingly popular worldwide especially in East Asia where a flat and/or concave irregular forehead is considered unaesthetic. We present our outcomes performing fat transfer to the forehead in combination with botulinum toxin (Botox) corrugator-frontalis injection where indicated in East Asians.

Methods From 2013 to 2017, 62 consecutive patients with flat and/or concave irregular unaesthetic foreheads underwent forehead fat transfer using a microautologous fat transplantation gun. Concomitant Botox injection to minimize corrugator and frontalis contraction-mediated fat displacement was indicated in 23 patients (thin forehead skin and/or excessive forehead animation or rhytides) to prevent forehead vertical crease formation. Thirty-nine subjects with a mean follow-up of 16 months (range = 3–44 months) had their pregraft and postgraft forehead contours assessed on an aesthetic grading scale. Of these 39, 17 completed forehead fat graft volumetric analysis using preoperative and postoperative 3D photography.

Results Aesthetic results were durable at latest follow-up, and all patients were satisfied with their final appearance. The mean amount of fat transferred was 7.72 mL (range = 1.5–33 mL). One subject required a repeat fat grafting (with Botox) because of vertical crease formation after the index procedure (without Botox). Another 12 needed a second fat-grafting session to optimize the contour. All who received Botox did not develop vertical creases. The mean ± SD forehead contour grade improved from 2.29 ± 0.77 to 3.24 ± 0.67 (P < 0.001). The percentage mean ± SD retention of grafted fat was 46.71% ± 5.77% with Botox versus 39.12% ± 5.24% without Botox (P = 0.006).

Conclusions Fat grafting to the forehead using our technique with selective Botox administration is an effective, simple, fast, inexpensive, and safe strategy for aesthetic forehead contouring especially for flat and/or concave foreheads. Forehead fat survival rate is objectively improved with simultaneous Botox injection. There is minimum downtime and long-lasting results with high patient satisfaction rates.

From the *Department of Plastic, Reconstructive, and Aesthetic Surgery, KK Women's and Children's Hospital, Singapore;

Craniofacial Research Center, Craniofacial Surgery, Department of Plastic & Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; and

Department of Chemical and Materials Engineering, College of Engineering, Chang Gung University, Taoyuan, Taiwan.

Received September 19, 2018, and accepted for publication, after revision September 21, 2018.

Conflicts of interest and sources of funding: none declared.

Reprints: Chun-Shin Chang, MD, MS, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, No 5, Fu-Hsing St, Guishan District, Taoyuan City 333, Taiwan, Republic of China. E-mail: frankchang@cgmh.org.tw.

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