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Archive for the ‘brow bone reduction’ Category

Mid-Forehead Approach for Male Brow Bone Reduction

Tuesday, February 10th, 2015

 

Reduction of the prominent brow bones can be done by two basic techniques and is done for different reasons/patient populations. (e.g., prominent male brow, part of facial feminization surgeries) The type of patient and the degree of brow bossing will determine the best surgical technique. In some cases augmentation of the forehead above the brow bone can also help reduce its appearance, either done alone or in combination with actual brow bone reduction.

Brow Bone Reduction by Burring X-Ray Dr Barry Eppley IndianapolisThe thickness of the brow bones (technically the thickness of the anterior bony wall of the frontal sinus) will largely determine the surgical technique of choice. When combined with the degree of brow prominence needed, the choice of reduction technique will be clear. The best way to determine the thickness of the anterior bony wall is a CT scan. This will allow one to measure the thickness of the anterior wall the whole way across the width of the brow bossing. A side to side assessment is very important and can not be judged just based on a lateral plain skull film alone. (better than no x-ray at all however)

Brow Bone Rerduction by Burring Dr Barry Eppley Indianapolis Preoperative X-RayIf the anterior wall of the brow bone is thick enough (usually 5mms or greater), a burring technique for reduction can be used. This is the simplest brow bone reduction technique and allows for the best degree of reshaping with a low risk of frontal sinus exposure. It is a technique much more commonly used in women than men because the degree of brow  bone reduction needed is often less. But is some men with adequate bone thickness, burring alone may be adequate for the central and adjoining medial brow areas where men have the greatest protrusions.

Male Brow Bone Reduction Mid Forehead Approach Dr Barry Eppley IndianapolisThe problem with brow bone reduction in men is usually one of access. While a full coronal scalp or frontal hairline incision is typically used, such incisions in men often poses aesthetic challenges based on their hairline location, density and pattern. One incisional option for a few select men is a horizontal forehead wrinkle. (if they have a fairly prominent one.

Mid-Forehead Approach for Brow Bone Reduction by Burring Dr Barry Eppley IndianapolisDirect Brow Bone Reduction by Burring with Supraorbital Nerve Isolation Dr Barry Eppley IndianapolisThrough a central horizontal forehead wrinkle incision, the brow bones can be easily accessed. One important feature of this forehead incision is not to make it too far lateral to avoid transecting the supraorbital nerves and causing permanent forehead and anterior scalp numbness. This allows a burring reduction technique to be done under direct vision where the exit of the supraorbital nerves can be seen and protected. Reduction can be aggressively done in the glabellar and medial half of the supraorbital rims with relative ease.

The central forehead incision for male brow bone reduction requires a thick anterior frontal sinus wall, an evident horizontal forehead wrinkle and an aesthetic reduction amount that does not exceed the bone wall thickness.

Dr. Barry Eppley

Indianapolis, Indiana

Techniques and Outcomes in Forehead and Brow Feminization

Sunday, September 28th, 2014

 

Forehead feminization Surgery Dr Barry Eppley IndianapolisFacial feminization surgery is a relatively recent plastic surgery procedure that has only been done since the late 1980s. It has been developed to address the need to modify masculine facial features for those with gender dysphoria who need to change their facial identity. As a result it is a well known need for the transgender patient. Certain facial features can have very specific male and female characteristics. Specifically the forehead and the jawline are especially important in facial gender identification.

In the October 2014 issue of the journal Plastic and Reconstructive Surgery, an article appeared entitled ‘Facial Feminization Surgery: The Forehead. Surgical Technique and Analysis of Results’. Over a four year period, the authors performed 172 forehead reshaping procedures. The results were assessed by cephalometric x-rays and a six month after surgery survey. The specific techniques discussed were incisional access and how the bone areas are specifically reshaped. Incisional access was done through either a hairline (pretrichial) or modified coronal based on the vertical length of the forehead and whether hairline lowering was simultaneously needed. The bone was reshaped through sequencing of frontonasal-orbital reconstruction/recontouring with osteotomy and setback of the anterior wall of the frontal sinus.

No serious complications were observed in this forehead feminization patient series. No hematomas, seromas or infections occurred. There were no complications related to osteotomizing the anterior wall of the frontal sinus such as sinus dysfunction, sinusitis, mucoceles, or air leaks. One patient did develop a cerebrospinal fluid leak from the posterior wall of the frontal sinus that resolved spontaneously within days after surgery by posture measures. Most patients had some degree of forehead numbness with complete recovery starting three months after surgery. No permanent injury to the frontal branch of the facial nerve occurred although some patients  had some weakness which fully recovered weeks after surgery. The average level of patient satisfaction by the after surgery survey was between satisfied and completely satisfied.

Brow Bone Reduction - Bone Flap Technique Dr Barry Eppley IndianapolisThis article highlights several technical aspects of the procedure that one learns by doing this type of surgery over the years. Where to place the incision and how to access the brow area must be initially considered. Whether to place the incision at or behind the hairline depends on how long the forehead is and the natural shape of the frontal hairline. Brow bone reshaping almost always requires removing the anterior wall of the frontal sinus, reshaping it and repositioning it further back into the frontal sinus. (burring reduction is inadequate and the anterior wall of the frontal sinus permits little reduction to be achieved) With the anterior wall of the frontal sinus removed, the nasal root and glabellar region must be reduced to create a more feminine frontnasal junction. Reduction/rehaping of the superolateral brow bone down along the lateral orbital wall must not be forgotten as a more comprehensive approach to the fronto-orbital recontouring.

Despite the rather invasive nature of this type of forehead surgery, complications are remarkably few and significant improvement is always seen. There can be issues that may require secondary revision such as the smoothness of the brow region. This article does not address whether any revisions were required but some low percent can be expected. (3% to 5%)

Brow bone reshaping and associated hairline modifications can effectively alter masculine facial features in the transgender patient with a very low incidence of negative side effects. To really change the forehead/brow area a comprehensive bone and soft tissue approach is needed.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Transgender Brow Bone Reduction/Reshaping

Tuesday, July 15th, 2014

 

Background: The shape of the forehead is very gender specific and these differences are well known. The male forehead has prominent brow ridges, a brow bone break and a forehead that has a slight backward slope. The female forehead has no visible brow ridging or break and a more convex shape as it extends upward into the frontal hairline. These forehead shape differences are driven largely by the influence of testosterone on the development of the frontal sinuses and the frontal bone.

Forehead feminization Surgery Dr Barry Eppley IndianapolisIn facial feminization surgery (FFS), forehead recontouring is an important one-third of the facial changes needed. This is usually perceived as ‘burring of the brow bone’ but this is an overly simplistic understanding of how to reshape the entire superior orbital rim. Because of the thinness of the outer cortex of the brow bone with a large underlying frontal sinus air space, simple burring of the frontal bone can only make a limited change. Most brow bone reductions of any significance require an osteoplastic bone flap technique in which the entire outer cortex is removed, reshaped and replaced.

But the brow bone reduction is often not enough to get a definitive gender change in the FFS patient. As part of the brow recontouring, the lateral or tail of the brow bone must be reduced to allow a more upward sweep to the tail of the eyebrow. In some cases, the orbital rim reduction may need to be carried around to the side to help with greater orbital exposure. (opening of the eye) Also, the frontal hairline may benefit from being advanced or lowered. If access to the brow bone reduction is done through a hairline or pretrichial approach, then vertical forehead reduction/hairline repositioning can be done at the same time as the brow bone reduction.

Case Study: This 35 year-old patient was undergoing a variety of facial feminization surgeries from the forehead down to the adam’s apple. The concerns on the forehead was that the brow bones were too strong but the upper forehead was adequately shaped/projected. The hairline was also in good place (not too high) with reasonable hair density.

Osteoplastic Brow Bone Reduction Technique front view Dr Barry Eppley IndianapolisOsteoplastic Brow Bone Reduction Technique side view Dr Barry Eppley IndianapolisUnder general anesthesia, a pretrichial or frontal hairline incision was made in an irregular fashion paralleling the direction of the hair shafts. The forehead flap was turned down and the brow bones exposed, protecting the supraorbital nerves. A reciprocating saw was used to take off the outer brow bones at the levels of the surrounding forehead. The two pieces were reshaped and put back with resorbable sutures. The tail of the brow bones were the frontal sinus cavities did not exist was burred done to reduce its prominence. The forehead flap was put back in a two layer closure with small sutures for the skin.

Transgender Brow Bone Reduction result side view Dr Barry Eppley IndianapolisTransgender Brow Bone Reduction result oblique view Dr Barry Eppley IndianapolisBrow bone reduction is usually more than just simple burring, particularly with the goal of changing a prominent masculine brow shape to a flatter more feminine one.  The osteoplastic bone flap technique is needed with the potential for additional procedures of lateral orbital rim contouring, forehead augmentation and hairline advancement done at the same time.

Case Highlights:

1) Brow reduction is an important part of many facial feminization surgeries.

2) Brow reduction can be done by burring but usually needs a more aggressive approach with an osteoplastic bone flap to create a more feminine brow shape.

3) Many FFS brow bone reductions can be done through a hairline or pretrichial incision which allows for a simultaneous hairline advancement if desired.

Dr. Barry Eppley

Indianapolis, Indiana

Five Things You Did Not Know About Brow Bone Reduction

Friday, February 7th, 2014

 

Brow bone reduction is often aesthetically necessitated when the frontal sinus air cavities become too large. This is almost exclusively a male problem since the development of the frontal sinuses is highly related to levels of circulating testosterone and growth hormone during development. As a result, it is often associated with other strong facial bone features in men as well. Very strong brow bones due to frontal sinus pneumatization is almost never seen in women.

Brow Bone Reduction - Bone Flap Technique Dr Barry Eppley IndianapolisWhile brow bone reduction can occasionally be done by a burring technique, the thin cortex of the overlying brow bone does not allow for more than a few millimeters of reduction with that approach. More substantial brow bone reduction requires an osteoplastic flap technique whereby the bulging bone cover of the frontal sinus is removed, reshaped and then replaced. This can increase the amount of brow bone reduction by three or four times than of just burring the bone.

When it comes to brow bone reduction surgery, here are five things you may not have known about it.

Brow Bone Reduction and Browlift Surgery Are Related. The osteoplastic technique for making the brow bone less prominent requires an open incision and forehead flap turndown for exposure. Several types of browlifts also require an identical surgical approach through either a hairline or scalp incision. This also means that a browlift can be done with brow bone reduction if needed, which often is the case in Facial Feminization Surgery.

Brow Bone Reduction and Migraine Surgery Can Be Done At The Same Time. For those individuals that suffer from frontal migraines caused by supraorbital nerve compression, decompression of the nerve by stripping off the surrounding muscle and opening up the bony foramen can reduce symptom frequency and intensity. Working on the brow bones requires coincidental exposure of the supraorbital nerve, thus potentially solving an aesthetic and pain problem during the same operation.

Frontal Sinusitis Is Not Caused By Brow Bone Reduction. While the osteoplastic technique does expose the frontal sinus cavity, often not leaving the underlying mucosal lining completely intact. such exposure does not place one at increased for subsequent sinus infections. Almost every frontal sinus cavity that i have ever seen is completely healthy and no patient has ever reported a frontal sinusitis problem later.

Air Leaks Are Uncommon Sequelae from Brow Bone Reduction Surgery. By taking off the overlying bone and some mucosal lining with it, broad frontal sinus exposure does occur. But putting back the reshaped bone provides a near complete seal on most cases. When small openings around the replaced bone are seen, which is common, patching of them are done. This is accomplished by a variety of materials from temporalis fascia, bone cement or even bone wax. Despite these efforts, it is possible that extreme sinus air pressure (usually from blowing one’s nose) can open up a small hole (‘blow hole’) right after surgery. This is seen by the filling up of the forehead with air. Time and avoiding blowing one’s nose usually makes this a self resolving problem as the tissues eventually scar down.

Upper Forehead Augmentation May Be Needed When The Brow Bones Are Reduced. Some prominent brow bone patients have the opposite problem in the upper forehead. While the lower forehead may be too prominent, the upper forehead may be too recessed or sloped backwards. This can be simultaneously treated by building up the forehead above the brow bones with bone cement after the brows are reduced. The angulation of the forehead in profile should be assessed before surgery to avoid missing this aesthetic problem and the opportunity to simultaneously correct it. (the ying and yang of forehead reshaping)

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: One-Sided Brow Bone Reduction

Tuesday, November 12th, 2013

 

Background: Prominent brow bones are the direct result of the development of the underlying frontal sinus. While all of the frontal forehead bone above the brows is very solid and thick skull bone, the brows are made up of air with only thin bone in front and back of its thickness. The anterior or frontal part of the brow bone beneath the eyebrows is remarkably thin, often only being a few millimeters thick.

Brow bone reduction is done for two main reasons. Men who have large and very prominent brow bones often want them reduced to look less ‘Neanderthal-like’. Women  with larger brow bones or men to women transgender patients who want a softer and more feminine appearance may want their brows reduced and the tail of the brow bone reduced and flared upward. In some cases simple burring may be effective to achieve these goals but most of the time the outer table of the frontal sinus bone must be removed and reshaped to get a significant reduction. The thin outer bone of brow bone makes only a few millimeters reduction possible with burring.

When the frontal sinus is enlarged, it most always involves both sides of the brow bones. This is because the frontal sinus in most people is paired and exists under both eyebrows. But the frontal sinuses are rarely symmetrical and the septum that exists between them frequently deviates to one or other side, allowing for one frontal sinus to become larger than the other. This can account for the rare occurrence of asymmetrical brow bone hypertrophy.

Case Study: This 33 year-old male had one enlarged brow bone that had bothered him for years. He had no specific history of trauma to the area. It had just developed naturally that way. It created the appearance of a large knot or ball on his brow that also pushed down into the eye socket, giving it a swollen appearance. He had no pain or numbness over the brow area.

Under general anesthesia, a coronal scalp incision was made way behind his hairline. A full-thickness scalp flap was raised down to the underside of the brows exposing the enlarged brow bone. The supraorbital nerve was identified and preserved. A reciprocating saw was used to remove the brow bone prominence. Internal osteotomies were made to infracture the part of the brow bone that had expanded into the orbit. Burring was done around the osteotomy site to remove additional protruding areas. The removed brow bone was reduced, reshaped and placed back as a cover with resorbable sutures over the exposed frontal sinus. The scalp incision was then closed with a total operative time of less than two hours. He was discharged later in the day as an outpatient.

Immediately during surgery the change in the brow bone was apparent with improved symmetry between the two sides of the brow bones. He went on to heal uneventfully with a satisfied symmetrical brow bone result.

Case Highlights:

1) Brow bone hypertrophy most commonly occurs on both sides and rarely on just one side.

2) Brow bone reduction is done through an open coronal (scalp) approach by removal and reshaping of the bone overlying the enlarged frontal sinus.

3) Brow bone reduction has no adverse effect on the frontal sinus.

Dr. Barry Eppley

Indianapolis, Indiana

Patient Testimonials: Brow Bone Reduction/Forehead Reshaping

Sunday, August 25th, 2013

Brow Bone Reduction and Forehead Reshaping

‘Had brow bone and forehead bone reshaping done recently by Dr. Eppley. The results are amazing. I had a really big protruding brow bone that made me look like a Neanderthal man. The whole process was very smooth and transparent. A large amount of bone was removed, some of it was reshaped and put back. This way not only sinus size was reduced, but also brow bone on the sides and along orbits was made smoother. Recovery was very quick, I was able to return to work two weeks after the procedure. 

If you have this kind of forehead problem I would recommend this surgery. I would get a 3D CT scan, as Dr. Eppley suggested to me, to make the consultation more productive and results more predictable.

Victor Z.

Durham, North Carolina

Commentary

For brow bones that are really prominent, particularly in men, the only really effective reduction method is going to be the osteoplastic bone flap technique. The anterior wall of the frontal sinus (visible brow bone ridge) is very thin, often less than 3 or 4mms, so to expect a significant change from burring is not going to happen. The entire brow bones must be removed, reshaped and then put back in place. By so doing up to 10mms of brow bone setback can be achieved. But no matter how brow bone reduction is done it requires a scalp incision to do it. Whether it is way back in the hairline or along the edge of the frontal hairline (women only) a turn down scalp flap is needed.

While all of this sounds quite ghastly the procedure actually is fairly easy to go though and has a quick recovery. Most patients have little pain after surgery and the biggest issue is some eyelid swelling and occasional bruising. By a week after surgery most people look good enough to walk around in public or even be at work without detectable signs of  having had surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Forehead Augmentation for Correction of Pseudo Brow Protrusion

Tuesday, August 20th, 2013

 

Background: A brow bone prominence is largely a male feature caused by a greater pneumatization (expansion of air cavity) of the frontal sinuses than in women. While female brow bones are relatively flat, most men will have some degree of prominence or ridging that creates a brow bone break as it ascends into the forehead. Thus some degree of a brow prominence is well tolerated in men and may even be aesthetically desireable as a strong gender trait.

Excessive pneumatization of the frontal sinuses creates a brow bone prominence that extends well beyond the natural plane or slope of the forehead. Whether a brow bone prominence in some cases is excessive is a matter of personal judgment, in others it is so extreme that it is obvious. Brow bone reduction surgery, usually by an osteoplastic flap method, is the only effective treatment to reshape this lower portion of the forehead.

When considering whether brow bone reduction should be done, the shape of the forehead above it must also be considered. In many cases, the upper forehead is normal and setback of the brow bones is all that is needed. In other cases, a combination of brow bone setback and forehead augmentation produces the best profile change. In rare cases, the brow bone position is normal and it is the excessively sloped forehead that is the culprit. (pseudo brow bone prominence.

Case Study: This 35 year-old male felt he had too strong of a brow bone and disliked his forehead shape. He had a significant retroclined angulation to his forehead and this raised the question as to whether his brow bones had too much horizontal projection or that the forehead projection was deficient. Computer imaging was done to determine whether brow bone reduction or forehead augmentation produced a better forehead profile appearance.

Under general anesthesia, he had a coronal (scalp) incision placed way behind his hairline (16 cms) and raised to expose his forehead down to his brow bones. The forehead above his brow bones was built up using 50 grams of hydroxyapatite cement into a smooth transition into the upper forehead and staying within the temporal lines and off of the temporalis muscles. (fascia)

His after surgery result showed exactly what was predicted by computer imaging beforehand. He has a much better forehead shape and his brow bone prominence was ‘gone’.  Changing the slope of his forehead was the source of his aesthetic forehead deformity.

Of great interest for any man is the risk of adverse scarring from a coronal scalp incision. Scalp incisions in men must be done with the greatest of care and concern for the aesthetic outcome. The healing of his incision, as judged across the top where his hair was the thinnest, was amongst the finest that I have ever seen. (very hard to detect even on the closest of inspection)

Case Highlights:

1) A prominent brow bone can be the result of a recessed forehead. (pseudo brow bone prominence)

2) Computer imaging done in the profile view can determine whether forehead augmentation or brow bone reduction produces the better aesthetic facial result.

3) Forehead augmentation is done through an open scalp incision and can be done with either hydroxyapatite or acrylic bone cements.

Dr. Barry Eppley

Indianapolis, Indiana

The Uniqueness of Male Plastic Surgery – Facial Procedures

Saturday, June 15th, 2013

 

The facial aging process is one that is well known as everyone will eventually see it on their face. The eyes get heavy, the brows descend, the cheek fall, jowls develop and the neck sags. Women become concerned earlier in the aging process and proceed to do procedures to treat or slow it down in an overall more comprehensive manner. Men take a much more delayed approach to it often waiting until one facial area becomes a major concern or until the facial aging process is fairly advanced.

While the face ages largely similar in both men and women, the facial procedures used to treat them are often done differently. Not as many men have facelifts as their aging neck and jowls are more tolerated. But in men that have facelifts they must be done very carefully, respecting the natural hairlines of the temples and behind the ears and being careful not to displace the beard skin into the ear canal. Incisions must be placed very inconspicously and often less of a tightening result must be accepted to keep the scars hidden. That is not a bad thing as men look better underdone than having their faces pulled too tight anyway.

While men also develop heavy upper eyelid skin and lower eyelid bags just like women, their eyelid lifts (blepharoplasties) need to be done more conservatively. Browlift options in men are more limited due to the frequent lack of adequate scalp hair and a well defined frontal hairline. The most common male browlift method is through the upper eyelid (transpalpebral browlift) using the endotine device to accomplish the lift. This produces a very modest browlift but creates no visible scars and with more conservative eyelid skin and fat removals can avoid overfeminizing the male face and creating an unnatural overdone look.

Men do not engage in as many Botox and injectable fillers treatments as women as some wrinkles and signs of aging are more tolerated. A more natural result for men is one that reduces the worst of the wrinkles but does not eliminate all of them. This is the same reason men, at best, will only do a bare minimum of facial skin care. Many men would rather seek more definitive surgical procedures, or do nothing at all, that engage in non-surgical procedures that require frequent efforts to maintain.

Facial reshaping surgery is vastly different in men than women. Male rhinoplasties must keep a high and straight dorsal line and avoid an overly upturned tip while most women desire a smaller less projecting tip and lower dorsal lines. The shape of the face in men is dominated by a strong jaw and requests for chin, jaw angle and even total jawline enhancements are not uncommon to pursue a more masculine appearance and even the so called ‘male model’ look. Men favor higher more angular cheek augmentations while women prefer a lower more anterior rounded cheek prominence. Men pursue brow bone surgery for either reduction of an overlying prominent one or for augmentation to create a more masculine brow prominence and a more backward sloping forehead profile.

Plastic surgery for men has its own unique requirements both in the type of surgeries and the demeanor of the patients. One should not assume that every plastic surgeon or plastic surgery practice is equally adept about meeting the needs of the male patient. Just like breast reconstruction for women or body contouring after massive weight loss, the male patient presents unique challenges for a satisfying surgical outcome.

Dr. Barry Eppley

Indianapolis, Indiana

Forehead Feminization with Combined Brow Bone Reduction, Browlift and Hairline Lowering

Sunday, April 21st, 2013

 

There are numerous surgical procedures to feminize a masculine facial appearance. They include jawline reshaping (chin and mandibular angle reduction), rhinoplasty, cheek reduction, tracheal shave and forehead reduction/reshaping. While every transgender patient’s face is different and may need just a few or all of these facial feminization procedures, the forehead is one of the top considerations for most patients. The female forehead has a very distinct shape with a rounded contour from the brows up to the hairline with no obvious bone break.

Forehead reshaping incorporates reduction of the prominence of the central glabellar region as well as the projection of the brow bones. The brow bones must not only be deprojected but should also have the tail of them near the lateral orbit reshaped to have more of a sweeping effect up and towards the temples. Since this procedure requires an open scalp approach, this creates the oportunity to lower the frontal hairline as well. Together this type of foreheadplasty has a significant impact on the gender identification of the face.

The prominent glabella and brow bones are always due to the pneumatization of the front sinus. In cases of minor protrusion, the outer table of the frontal sinus can be simply burred down. Unfortunately this rarely can be successfully done due to the thin bone thickness overlying the frontal sinus. A few millimeters of change is rarely enough to make a noticeable external change. Most patients require the anterior wall of the bone to be removed, reshaped and repositioned back into place with resorbable sutures or metal microplates and screws. This method sets back the bulging bony prominence while preserving sinus function. The outer brow bone areas that lie outside of the sinuses can be reshaped as desired by burring.

When significant brow bone reduction is done (flattening of the bone), there is the potential for an excess of overlying skin. Loose skin on the brows can result in sagging or overlying brow ptosis. This can be easily addressed at the time of the brow bone reduction by a comcomitant browlift using the transcoronal or hairline incision made for access to the brow bones. An alternative approach is a direct browpexy from the galea below the eyebrows to underlying bone holes or the fixation plates (if used) above the reshaped brow bones.

A final component of the feminizing foreheadplasty procedure is the potential to simultaneously lower the frontal hairline. A long forehead (> than 6.5 to 7 cms between the brow and hairline) is unaesthetic for any gender but is particularly so in the male to female transgender patient. If a hairline approach (trichophytic) is used, a simultaneous scalp advancement can be done by securing the galea of the advanced scalp by sutures to bone holes in the outer table of the skull. By bringing the scalp forward, the lifted forehead skin will need to be trimmed creating a combined forehead skin reduction and browlift.

Ultimate feminization of the forehead can be done by simultaneous brow bone reduction, browlift and hairline lowering.

Dr. Barry Eppley

Indianapolis, Indiana

Postoperative Instructions for Brow Bone Reduction Surgery

Tuesday, April 9th, 2013

Most brow bone reductions need to be done through an open scalp incision. Unless the amount of brow bone reduction is very minimal (a few millimeters) the underlying frontal sinus must be factored into the operative technique. Brow bone reductioin can be done by burring, burring and infracture and removal of the brow bone with reshaping and replacement.

The following are the typical instructions for brow bone reduction:

1. Brow bone reduction is associated with a only a very moderate amount of pain in the first few days after surgery.  Narcotic pain medications are prescribed and use them if you need them. In a few days, you may switch to Tylenol or Ibuprofen or alternate between doses with the narcotic medication.

2.  There will be a circumferential head wrap placed right after surgery. This is in place to control extreme swelling and does not play a role in maintaining the new position/shape of the brow bones. You may take it on the next day after surgery. If it should get loose or come off during the night, just leave it off. It is not a critical part of brow bone reduction surgery.

3.  The sutures in the scalp incision are dissolveable and do not need to be removed. There is no need to apply antibiotic ointment to the incisions as all it will do is make your hair greasy and be hard to shampoo out.

4. Bruising and swelling will develop around the eyes after surgery which is perfectly normal. In some patients the eyes may almost swell shut by the second day after surgery.

5. You may shower and wash your hair 48 hours after surgery. There is no harm in getting your sutures wet with soap and water.

6. Your forehead will feel stiff and may not move normally for up to a month after surgery. It will also feel numb for even longer. This is all normal and as the feeling comes back in the forehead you will experience strange sensations such as shooting pains or itching as the nerves recover.

7. You may wear any type of hat around your forehead whenever you feel comfortable doing so.

8. There are no restrictions on normal daily activities after the surgery. You may do light exercise anytime afterwards that you feel comfortable. But no strenuous exercise that involves bending over for three weeks after surgery.

9.   You may drive within several days after the procedure, provided you are off pain medication and can react normally to driving conditions.

10.  If any redness, tenderness, or increased swelling develops on the forehead or around the eyes after the first week of surgery, call Dr. Eppley and have your pharmacy number ready.


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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