Medial Brow Restoration Following Paramedian Forehead Flap Reconstruction: A Surgical Technique

Objective: The paramedian forehead flap is a versatile and widely used reconstruction technique for nasal defects. Although it can provide excellent aesthetic outcomes, the medial brow can be disrupted, leading to facial asymmetry and patient dissatisfaction. We describe a simple and reliable surgical technique for medial eyebrow reintegration performed at the time of forehead flap pedicle division. Methods: Between 2015 and 2024, 146 patients underwent medial eyebrow reconstruction using this technique at the time of their pedicle division. During the second stage of the forehead flap during pedicle division, a standardized technique using a semicircular incision and flap inset was employed to reposition the medial eyebrow into continuity with the remaining brow. Patient outcomes were assessed through follow-up visits, and aesthetic outcomes were reviewed descriptively. Results: One hundred forty-six patients underwent eyebrow reconstruction using this method at the time of the division of their forehead flap. All patients achieved natural-appearing medial-to-lateral brow continuity with high levels of satisfaction. Minor revisions were required in a limited number of cases including sensitive neuroma, and contour deformities. Conclusions: This reconstruction technique allows for reliable aesthetic restoration of the medial eyebrow after forehead flap reconstruction. It can be easily incorporated into standard practice during pedicle division and improves symmetry and patient satisfaction.