Facial Surgery

Toshitsugu Hirohi, MD; Koji Nagai, MD; Donald Ng, MD; andKiyonori Harii, MD

Abstract
Background: Achieving aesthetic results with forehead augmentation procedures remains challenging. We have developed a method of integrated
forehead and temporal augmentation using a three-dimensional (3D) printing-assisted methyl methacrylate implant.
Objectives: The study objective was to assess the importance of combined temporal augmentation when performing forehead augmentation.
Methods: We identified 34 patients (from 2000 to 2010) who underwent forehead augmentation with a methyl methacrylate implant contoured insitu during surgery and 41 patients (from 2010 to 2016) who underwent integrated forehead and temporal augmentation with a prefabricated methyl
methacrylate implant. We conducted a retrospective chart review of patient data including operation time, complications, and instances of revision surgery. Two blinded plastic surgeons scored the aesthetic results of the operations on a 4-point scale (1, poor, to 4, excellent) based on preoperative andposttreatment photographs.
Results: The integrated augmentation method resulted in a lower frequency of posttreatment implant removal (one [2%] vs. six [18%]; P < .05), alower frequency of filler injection for touch up (one [2%] vs. six [18%]; P < .05), and higher mean aesthetic scores (3.7 ± 0.5 vs. 2.2 ± 1.0; P < . 001) compared to the forehead augmentation method. There was no statistically significant difference in surgical complications between the two groups.
Conclusions: Integrated forehead and temporal augmentation using a 3D printing-assisted methyl methacrylate implant may be the optimal available
procedure, enabling the custom fabrication of contours requested by the patient and providing a rejuvenating and balancing effect on facial appearance.

Level of Evidence: 3

Editorial Decision date: March 16, 2018.

The contouring of the forehead affects the aesthetic
appearance of the periorbital and midface regions and isimportant for determining the overall appearance of theface. A rounded, full, or smoothly surfaced forehead is typically considered attractive, whereas a narrow, flattened,or retruded forehead may be less desirable. The supraorbital ridge contours can markedly enhance the aesthetic
features around the orbits.1 The forehead, glabella, andradix represent a critical triad in aesthetic rhinoplasty,
forming the nasofrontal angle.2 For these reasons, foreheadaugmentation has become popular among Asians as partof a comprehensive approach to improve their facial features aesthetically.3–6

Forehead augmentation has been performed in various ways, including the placement of alloplastic implants,
injection of absorbable dermal fillers, and autologous fat
grafting.5–7 Silicone implants, at one time the first choiceDrs Hirohi and Nagai are plastic surgeons in private practicein Tokyo, Japan. Dr Ng is a plastic surgeon in private practicein Singapore. Dr Harii is a Professor, Department of Plastic,Reconstructive, and Aesthetic Surgery, Kyorin University School ofMedicine, Tokyo, Japan.
Corresponding Author:
Dr Toshitsugu Hirohi, Ritz Cosmetic Surgery Clinic, 1-7-8,
Ebisuminami, Shibuya-Ku, Tokyo 150-0022, Japan.
E-mail: hirohi@ritz-cs.com

Downloaded from https://academic.oup.com/asj/advance-article-abstract/doi/10.1093/asj/sjy075/4955215 by Koji Nagai on 13 September 2018

Integrated Forehead and Temporal
Augmentation Using 3D Printing-Assisted
Methyl Methacrylate Implants

Aesthetic Surgery Journal
2018, 1–12
© 2018 The American Society for
Aesthetic Plastic Surgery, Inc.
Reprints and permission:
journals.permissions@oup.com
DOI: 10.1093/asj/sjy075
www.aestheticsurgeryjournal.com