Flat Incision Technique for Reconstructive Brow Surgery: A Wound Healing Model and Clinical Evaluation

Background: Skin incision is considered to be placed at 90° in reference to the skin to get perfect wound edge adaptation. The incision on hair-bearing tissues, as the scalp, is considered to be bevelled at 45° to promote hair growth through the scar. There is no consensus about the preferred incision angle on the brow. The aim of this article was to demonstrate the feasibility of the "flat incision technique" for brow repositioning, where brow deformation results after forehead reconstruction. A wound-healing model for the bevelled incision is presented. Methods: Brow incisions are bevelled with an angle of 20°. The lower incision is placed inside the brow so that the upper 2 rows of hair are included; the dermis is completely transected and dissection is continued into the subdermal plane. The procedure is presented in a patient who underwent resection of the forehead due to melanoma. Results: The bevelled incision increases the surface area of dermal layer by a factor of 2 compared with the standard vertical skin incision at 90°. Loss of the dermal tissue integrity and continuity due to trauma hinders the recovery of cell migration and function, resulting in a more prominent scar formation. It appears reasonable that with the increased surface area of the dermal layers in the wound edges, the scar quality improves. The case study demonstrates the feasibility of the procedure. Conclusion: The bevelled 20° incision for brow repositioning and reshaping showed to be a viable and predictable procedure. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Published online 26 February 2018. Received for publication August 22, 2017; accepted January 5, 2018 Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors. Dominik L. Feinendegen, MD, Institute of Plastic, Reconstructive and Aesthetic Surgery, Dufourstrasse 38, 8702 Zürich-Zollikon, Switzerland, E-mail: dr.feinendegen@feinendegen.ch Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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