: Primary aesthetic hairline lowering, also known as forehead reduction, is a relatively unexplored procedure and the perceived satisfaction with outcome has not been previously discussed in the scientific literature. The objectives of this study were to review the surgical technique and to analyze outcome assessing objective reduction, improvement of facial balance, patient satisfaction and complications.

: This was a prospective cohort study of patients seeking aesthetic forehead reduction since 2010. Inclusion criteria were: women with a high but stable hairline. We excluded smokers, those seeking combined surgery and those who had history of scalp surgery or hair loss. All patients were operated following the same protocol. Forehead reduction was measured comparing the pre and post-operative distance from glabella to trichion. Improvement in facial balance was assessed comparing the pre and post-operative quotient between upper and middle thirds of the face. The forehead FACE-Q tool and the Vancouver Scar Scale were used to assess patient satisfaction. All complications were registered with a minimum follow-up of 6 months.

: Twenty six women, aged 16 to 56 years were included. The average reduction was 2.03 cm. The facial balance quotient improved from 1:1.44 preoperatively to 1:1.05 postoperatively (p < 0.01). Both the forehead FACE-Q and the Vancouver Scar Scale showed significantly positive results. Complications included transient scalp numbness in 23 subjects, 3 small areas of scar widening and 1 minor seroma.

: With meticulous execution aesthetic forehead reduction in female patients is effective and safe resulting in high patient satisfaction.