Background: Achieving effective upper-face rejuvenation through forehead augmentation is essential; however, complications such as vascular occlusion leading to skin necrosis or vision loss can occur. The complex forehead anatomy, characterized by ligaments and septa, often results in uneven outcomes with dermal filler treatment. The learning curve for successful forehead augmentation was longer than that anticipated. Herein, we present a specialized program for clinicians to expedite the learning process. This study explores a five-step technique for forehead augmentation using high elastic (G prime) hyaluronic acid fillers. 

Methods: We enrolled 10 Asian female participants with no history of dermal filler injections, surgery, or nonsurgical forehead procedures. All participants provided written informed consent, and their progress was assessed using photography and the Global Aesthetic Improvement Scale.

Results: Immediate post-treatment Global Aesthetic Improvement Scale ratings averaged 3.0 ± 0.0, decreasing to 2.5 ± 0.5 at 6 months, and 1.8 ± 0.6 at 12 months. Mild tenderness (10%), temporary swelling (30%), and a rapid recovery period underscored the safety and reliability of our approach. Importantly, no adverse vascular events were observed.

Conclusions: Our five-step injection technique utilizing high-G prime hyaluronic acid leverages a profound understanding of the forehead anatomy, systematic methodology, and dynamic potential of advanced fillers. By implementing this paradigm, plastic and reconstructive surgeons can increase the standards of forehead augmentation and consistently achieve harmonious and effective results.