Repair of a Complex Forehead Defect Involving the Brow

In 2016, a 71-year-old male patient underwent a complex forehead and eyebrow reconstruction following the removal of a recurrent basal cell carcinoma via Mohs surgery, which left a 3.5 × 2.8 cm defect. The reconstruction was challenging due to the need to preserve the direction of hair growth in the eyebrow. The authors opted for a two-step process, initially allowing the wound to heal by secondary intention, reducing the defect size, and then performing an eyebrow reconstruction two months later. They harvested a combined free skin and hair-bearing full-thickness skin graft from the contralateral eyebrow, ensuring the entire hair follicle was included and the hair growth direction was preserved. The graft was then placed and sutured into the defect. Although telogen effluvium occurred, resulting in complete hair loss on the graft at four weeks, hair regrowth was evident at 12 weeks, and the growth rate matched the contralateral eyebrow, eliminating the need for frequent trimming. This method was presented as an alternative for patients with wide wounds involving the forehead and eyebrow, with the advantage of not requiring frequent eyebrow trimming compared to other methods like postauricular grafts or microfollicular hair transplants from the occipital scalp.