An open wound around a forehead implant placed about 20 years ago: how should it be approached?
An open wound around a forehead implant placed about 20 years ago: how should it be approached?
An open wound around a forehead implant placed about 20 years ago: how should it be approached?
Implants are sometimes inserted to enhance forehead volume and contour.
Not every patient with a forehead implant develops a problem, but inflammation or infection can sometimes require further treatment.
In particular, if an open wound persists without healing while an implant remains,
or a previously treated area reopens, both the visible wound and the remaining implant and surrounding tissue need assessment.
This patient had undergone forehead implant insertion at another institution approximately 20 years earlier and presented to our clinic with open wounds at the left temple and hairline.
Patient history at a glance
- Approximately 20 years earlier: forehead implant insertion at another institution
- 2024: hair transplantation
- Subsequently: inflammation and an open wound at the left temple
- June 2025: debridement of necrotic tissue and partial forehead implant removal at a university hospital
- Subsequently: the previously treated left temple wound reopened
- At presentation: open wounds measuring approximately 11×9 mm at the left temple and 10×10 mm at the left forehead hairline
- Surgical plan: removal of the remaining forehead implant, debridement of necrotic tissue, and wound preparation and closure
- Concurrent surgery: forehead reduction incorporating the open hairline wound and endoscopic forehead lift
- Operative findings: a forehead implant with a missing portion on the left from previous partial removal and a remaining implant segment
- Additional findings: the two open wounds at the left temple and hairline communicated beneath the skin, with muscle necrosis along the connecting tract
The key feature of this case was not simply removal of a forehead implant approximately 20 years old.
Despite previous debridement and partial implant removal, the left temple wound had reopened and a separate open wound was present at the hairline.
The operation therefore required assessment of the extent of the wounds and surrounding tissue, as well as removal of the remaining implant.
The previously treated temple wound had reopened
At presentation, an open wound measuring approximately 11×9 mm was identified at the left temple.
This was not a new wound.
It had been treated during debridement and partial forehead implant removal at a university hospital, but had subsequently reopened.
An open wound measuring approximately 10×10 mm was also identified at the left forehead hairline.
There were therefore two open wounds, one at the temple and one at the hairline.
When a wound persists or recurs after treatment,
and previous surgery removed only part of an implant, assessment should include the remaining implant and surrounding soft tissue as well as the visible wound.
Two separate surface wounds were connected beneath the skin
A particularly important finding emerged during the operation.
From the surface, the left temple and left forehead hairline appeared to have two separate open wounds.
Intraoperative examination, however, showed that they communicated in the subcutaneous layer.
Muscle necrosis was also observed along the tract connecting them.
Treatment therefore had to follow the actual operative findings, rather than estimate the affected tissue solely from the size of the surface wounds.
The identified necrotic tissue was removed, the operative area irrigated, and the wounds prepared.
These were findings in this particular patient. Not every forehead implant problem produces the same wounds or tissue changes.
The remaining forehead implant was identified after previous partial removal
The patient had undergone partial forehead implant removal at a university hospital in 2025.
At this operation, part of the implant's left side was missing, while the rest remained.
The remaining forehead implant was identified and removed.
Even after an implant-removal operation, part may remain if the procedure was partial rather than complete.
If a wound persists or recurs, it is therefore necessary to establish both the extent of the previous removal and how much implant remains.
Particularly when open wounds and necrotic tissue coexist, as in this case, assessment must extend beyond removing the implant to identify surrounding tissue requiring treatment
and determine how far the wound extends according to the actual findings.
The open hairline wound was incorporated into the forehead reduction
This patient also had an approximately 10×10 mm open wound at the left forehead hairline.
The forehead-reduction plan therefore included the open hairline wound within the surgical area so that it could be addressed concurrently.
The recurrent left temple wound was also prepared according to the tissue findings and closed again.
In addition to forehead reduction incorporating the hairline wound, an endoscopic forehead lift was planned with consideration of the forehead and the position and balance of both brows.
However, not every patient undergoing forehead implant removal requires forehead reduction or an endoscopic forehead lift.
The necessary approach varies with implant position and size, skin and soft-tissue condition, hairline and brow positions, wound location and extent, and the changes the patient wishes to achieve.
The combined procedures in this case were likewise planned around the findings in this individual patient.
Forehead implant removal may involve more than taking out the implant
Patients seeking forehead implant removal do not all present with the same condition.
Some seek removal because of dissatisfaction with implant shape or position; others, as in this case, have open wounds, necrotic tissue, previous partial removal, and a residual implant.
Depending on the patient's condition, planning may therefore require assessment of the following.
- How much implant remains
- Where the implant is located
- The condition of surrounding soft tissue
- How far the open wound extends
- Whether necrotic tissue needs removal
- Whether wounds that appear separate are also separate internally
- The extent of wound preparation and closure required after implant removal
In this patient, two apparently separate wounds at the temple and hairline were found during surgery to communicate beneath the skin, with muscle necrosis along the connecting tract.
Treating the visible surface wounds alone may therefore require a different approach from determining the surgical extent after examining the residual implant and surrounding tissue.
A forehead implant approximately 20 years old: its current condition matters more than its age
This case does not establish that inflammation or wounds occurred because the implant was 20 years old.
Duration in place alone cannot determine whether complications occur, and not all old implants require removal.
The important features were not the approximately 20-year interval itself, but the previous partial removal, residual implant, reopening of the treated temple wound, a separate hairline wound, and operative findings of subcutaneous communication with muscle necrosis along the tract.
The remaining implant was therefore removed, identified necrotic tissue was debrided, and the left temple and hairline wounds were treated according to their respective conditions.
The open hairline wound was included in the forehead reduction, and an endoscopic forehead lift was performed with consideration of the forehead and both brow positions.
The current condition matters, not simply the implant's age
The message of this case is not that old forehead implants are dangerous.
If an open wound or similar problem develops after forehead implant surgery, planning should assess the remaining implant, wound extent, and surrounding tissue rather than rely on duration in place alone.
Especially when wounds persist or reopen despite previous partial removal or wound treatment, the remaining implant and tissues beneath the skin need reassessment.
Implant removal involves more than taking the implant out: it requires identifying the current condition and extent of treatment needed, then planning removal and wound management accordingly.
For questions about endoscopic forehead implant removal, contact 02-545-3700 or "UVOM Plastic Surgery" on KakaoTalk.