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School of Medicine, West Virginia University, Morgantown, West Virginia, USA Correspondence: Dr Paul Ghareeb, School of Medicine, West Virginia University, 1 Bakers Point, Morgantown, West Virginia 26505, USA. Telephone 304-546-9253, fax 304-777-4679, e-mail [email protected] Forehead reconstruction is often challenging due to the aesthetic prominence of the area and difficulties in matching skin colour, contour and texture. Additionally, the forehead is typically a ‘donor’ site for facial reconstruction and lacks the abundance of matching adjacent tissue. Tumours (most commonly sun-related skin cancers) as well as trauma, congenital lesions and burns, make forehead reconstruction a common plastic surgical challenge. The size and location of the defect dictates the most appropriate approach, with the simplest usually being the most successful (1). However, larger defects require more complex techniques. The reconstructive ladder for forehead wounds is reviewed to determine the best approach for each specific patient. Defects may be repaired using any of the following: healing by secondary intention, primary closure, skin grafting, local flaps, tissue expansion, regional flaps and free flaps. The optimal approach is often the simplest and strives to replace tissue with like tissue. With larger defects, the surrounding tissue must be recruited in a tension-free fashion to optimize the scar and terminal blood flow. We present an advancement flap for the repair of central and lateral forehead defects up to 8 cm in size that applies principles of the periglabellar flap as previously described by Birgfeld and Chang (2).