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Bony Forehead Reduction with Hairline Advancement

 

The long or high forehead can be challenging to treat. The vertical length of the forehead is typically judged to be too long if the distance from the eyebrows to the frontal hairline exceeds about 6.5 cms. This is obviously a subjective judgement as the aesthetics of the forehead defies any exact number. But when the length of the forehead violates the 1/3 rule (bigger than the lower middle and lower facial thirds) it will be typically thought of as being too long or high.

Forehead Reduction with Hairline Advancement intraop top view Dr Barry Eppley IndianapolisShortening the height of the forehead is usually done by a forehead reduction procedure known as a hairline lowering. This is really a scalp advancement which is done by undermining and mobilizing the entire scalp all the way back to the nuchal ridge of the occiput. Combined with galeal releases the frontal hairline may be capable of being lowered 2 to 3 cms in many patients. Such forehead reduction is very powerful and can have a dramatic effect on the appearance of the upper face.

When considering a hairline advancement, it is also important to assess the shape of the bony forehead as well. Frontal bossing can be a contributing factor to a large forehead. While bring the hairline forward may begin to cover a bony protrusion it can not completely obscure it.

Forehead Bone Reduction for Frontal Bossing Dr Barry Eppley IndianapolisForehead Reduction with Hairline Advancement intraop side view Ddr Barry Eppley IndianapolisA total forehead reduction procedure consists of both a hairline advancement and bony forehead reduction. They can be done through the same pretrichial incision. By reflecting the forehead skin down to the brow bones, the frontal bone is exposed and can be burred down and reshaped. The limits of the bone reduction are based on the thickness of the frontal bone but usually can be reduced at least 5 to 7mms. Often times it is the slope of the bony forehead that needs changing as much as how far it protrudes forward.

Reducing the bony forehead and changing its slope also provides more room for additional hairline advancement. Its reduction may allow an additional .5cm of hairline advancement to be achieved.

Dr. Barry Eppley

Indianapolis, Indiana

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Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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