All these vessels are lined vertically and permit safe and effective transfer of the forehead flap on multiple individual vascular pedicles. The pedicle is the anatomic part that resembles the stem of the flap. The perfusion of the paramedian forehead flap comes from three sources: randomly, through the frontalis muscle and through the supratrochlear artery. Because the forehead flap is an axial flap with a pedicle containing its dominant vessel, the pedicle can safely be narrowed to 1 to 1.2 cm. Flap design Four types of flap design are historically described in literature: the median forehead flap, oblique forehead flap, sickle flap and vertical paramedian forehead flap. However, the vertical paramedian forehead flap based on the ipsilateral or contralateral supratrochlear vessels has become standard, because it has a low turning point, making it easy to reach the defect without using hair-bearing scalp. Also, primary closing of the proximal forehead is possible as a result of the narrow pedicle. Lateral nasal defects are usually closed with an ipsilateral paramedian forehead flap. Central nasal defects can be reconstructed using either a right- or left-sided forehead flap. The ipsilateral pedicle is closer to the defect than the contralateral pedicle, therefore the flap can be made shorter when using the ipsilateral side. Some experts suggest that a contralateral flap is easier to rotate, but this difference is minimal. The only problem with the contralateral flap is the extra length needed, not the difficulty of the technique. Most foreheads are at least 5 cm long, when measured from eyebrow to hairline. This is usually enough to resurface the entire nose using a vertical paramedian forehead flap design. Still, there are some short foreheads. A forehead is called short when it is shorter than 4.5 cm. When using the forehead flap on a short forehead, there are multiple ways to get the length that is needed. First, the turning point of the flap can be moved down, so that the base of the flap is closer to the nasal defect and a shorter flap can be used to reach the nasal defect. Second, the distal end of the flap can be placed within the hairline. The reconstructed nose will then have some hair on it, but it can be plucked, depilated or lasered. Principles of aesthetic regional unit repair Aesthetic regions are used to describe the normal features of the face. These regions (forehead, cheeks, eyelids,