Advancement flaps for large defects of the eyebrow, glabella, forehead, and temple.

PURPOSE: To describe a system for reconstruction of large defects of the eyebrow, glabella, forehead, and temple. The system maximizes the use of direct approximation and advancement flaps before resorting to less aesthetic techniques.

METHODS: This was a retrospective cohort study drawn from approximately 70 patients with post-Mohs defects of the eyebrow, glabella, forehead, and temple. Surgical intervention involved the graded application of direct approximation, horizontally oriented advancement flaps, rotational flaps, and free skin grafts. The selection of individual and combined techniques was based on defect area and depth, elasticity of adjacent tissues, and relations of the defect to the neighboring eyebrows and hairlines.

RESULTS: Reconstructive techniques applied to defects of the eyebrow, glabella, forehead, and temple can be arranged in an incremental scale that provides progressively more tissue but at an escalating aesthetic cost. The usual defect size limits for direct approximation and advancement flaps can be expanded.

CONCLUSIONS: To avoid the limitations of large rotational flaps and skin grafts in this region, maximal use of direct approximation and advancement flaps is recommended.