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Archive for the ‘hairline advancement’ Category

Case Study – Total Forehead Reduction

Saturday, July 30th, 2016

 

Background: The shape and size of the forehead is an important aspect of facial aesthetics. It is well known that it should compose up to one-third of the vertical facial height.  When exceeding this one-third proportion the forehead can look too large or be too dominant.

The most common reason for a large forehead is a high hairline. The distance between the eyebrows and the frontal hairline is long (usually greater than 6 to 6.5cms) and as a result the forehead looks big. This managed by a hairline advancement whose degree of forehead reduction is controlled by the amount of scalp laxity or how much it can be surgically mobilized.

A more infrequent cause of a prominent forehead is frontal bossing. This is an overgrowth of bone of the forehead, usually the upper portion, which makes it stick out often beyond the projection of the brow bones. The disproportion of the strong upper forehead makes the forehead look imbalanced in addition to being too large. In an adult, the only method of frontal bossing reduction is removal of bone through burring. How much the frontal bossing can be reduced is a function of the thickness of the outer cortex of the skull.

Case Study: This 45 year-old female had a very prominent forehead due to a combination of frontal bossing and a high hairline. (8cms)

Forehead Bone Reduction for Frontal Bossing Dr Barry Eppley IndianapolisForehead Reduction with Hairline Advancement intraop top view Dr Barry Eppley IndianapolisUnder general anesthesia through a frontal hairline incision, the frontal bone was burred down to the diploic space. The amount of bone reduction can be seen with one side reduced (left) and the other untreated. (right) The scalp was then mobilized all the way to the back of the head down to the nuchal ridge and brought forward for her hairline advancement.

Total Forehead Reduction result side view Dr Barry Eppley IndianapolisTotal Forehead Reduction result oblique view Dr Barry Eppley IndianapolisTotal Forehead Reduction result front view Dr Barry Eppley IndianapolisTotal Forehead Reduction hairlinke scar result Dr Barry Eppley IndianapolisHer immediate results showed a dramatic improvement on her forehead shape and proportion. The hairline scar had healed fairly well particularly in the central area which is under the greatest tension.

Total forehead reduction is a combination of frontal bone reduction and a hairline advancement. Both are done through a single hairline incision that extends down into the temporal hairline.

Highlights:

1) A prominent forehead can be caused by with a high hairline, bossing of the frontal bone or both.

2) Total forehead reduction is a combination of frontal bone reduction and a hairline advancement and provides maximal improvement of forehead shape.

3) The pretrichial hairline scar can heal fairly well even though it is under tension at the most central ares of closure.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Forehead Bony Reduction with Hairline Advancement

Monday, July 18th, 2016

 

Background: The shape of the forehead is largely controlled by the development of the frontal bone of the skull. Frontal bossing is the term given to describe a prominent bulging forehead. This is usually most manifest in the upper forehead which can project outward beyond the wide profile of the brow bones in some cases. There are a variety of medical conditions that can cause frontal bossing from congenital skull deformities to hormonal abnormalites. (e.g., acromegaly)

But for many patients this is an aesthetic deformity that has no specific cause other than this is just how the forehead developed. The prominent upper forehead usually appears as a bulge across the upper forehead. It is obvious because it has a size bigger than the patient’s brow bones and also causes a high or long forehead in some patients. A large surface area forehead causes a facial imbalance and disrupts the aesthetic thirds of facial proportions.

Frontal bossing can be reduced to improve facial aesthetics. How much the prominent frontal bone can be reduced depends on the thickness of the bone. Burring reduction is the surgical technique, not formal bone removal (frontal craniotomy) and split bone reduction as would be done in more severe craniofacial deformities.

Case Study: This 23 year-old female had a prominent upper forehead that was aesthetically bothersome to her. She wore her hair short so the entire shape of the forehead was clearly evident.

Forehead Bony Reduction with Hairline Advancement intraop result left oblique view Dr Barry Eppley IndianapolisUnder general anesthesia a pretrichial hairline incision was used to access the forehead. Burring reduction of 5 to 6mms was done throughout the forehead bulge down to a bleeding diploic space. The frontal hairline was then advanced 1 cm from upper temporal to upper temporal areas. The combination of some reduction of the frontal bossing and skin shortening of the forehead created a more balanced looking forehead region.

Total Forehead Reduction result side view Dr Barry Eppley IndianapolisThere are limits as to how much frontal bossing can be burred down. It may be able to be burred down completely or only partially. The hairline advancement provides an adjunctive improvement as it alone creates the appearance of a smaller forehead.

Highlights:

1) Frontal bossing is an aesthetic forehead deformity that is associated with an enlarged upper forehead and a high hairline.

2) The amount of reduction possible for frontal bossing depends on the thickness of the frontal bone.

3) A pretrichial approach to forehead bony reduction allows for frontal hairline advancement as well.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Total Forehead Reduction

Thursday, November 26th, 2015

 

Background: The shape of the forehead is affected by various hard and soft tissue components. The forehead is framed by the hairline superiorly, the brows inferiorly and the bony temporal lines to the sides. The projection of the forehead is controlled by the thickness of the frontal bone and its degree of convexity and smothness. The height of the forehead is judged by the vertical distance from the hairline to the brow.

Vertical forehead reduction can be of benefit when the hairline to brow distance is about 6.5 cm and longer. Numbers aside, one knows when the forehead is too long by their own aesthetic sense. Shortening the length of the forehead is done by moving the hairline forward or more inferior through extensive scalp undemining and mobilization. A powerful procedure, the hairline or scalp advancement can make a dramatic difference in the appearance of the upper third of the face.

Bony forehead reduction is done to either narrow the shape of the forehead or eliminate any obvious bony projections. This is a bone burring technique that is usually done to narrow the width of the forehead, reduce the amount of its forward projection (convexity) or smooth down so called forehead horns. This almost always need to be done through an open approach afforded by a hairline incision.

Case Study: This 40 year male had a long forehead due to receding frontal hairline and a wide and bulging forehead due to its bony shape. He had a prior hair transplant procedure with a linear strip scar on the back of his head. His desire was for a shorter forehead length and a less wide and bulging forehead.

Total Forehead Reduction result front view Dr Barry Eppley IndianapolisTotal Forehead Reduction result oblique view Dr Barry Eppley IndianapolisDue to his prior hair transplant harvests from the back of his head, it was elected to do a first stage scalp expansion to ensure enough scalp could be mobilized for the hairline advancement. This was done using 120cc of scalp expansion by fill volume. During the second stage through a hairline incision, the tissue expander was removed, the bony forehead reshaped by burring and the hairline advanced 2 cms. Small temporal rotational scalp flaps were also done to eliminate the temporal recession areas.

Total Forehead Reduction result side view Dr Barry Eppley IndianapolisTotal forehead reduction can be done through bony contouring and a hairline advancement. Using the ‘central’ pretrichial hairline incision positioned between the forehead and the scalp, both forehead reduction procedures can be successfully done. His history of strip occipital harvests for hair transplants did necessitate a first stage scalp tissue expander which would not normally be needed in most cases.

Many patients with high and long foreheads have a combination of a posteriorly recessed hairline and bony forehead bossing. Preoperative computer imaging will show whether the apparent forehead bossing is a function of just a high forehead and an exposed upper forehead bony contour or whether a true excessive forehead convexity exists. A very wide or broad forehead in the frontal view, however, is an excessive bony width problem for which a hairline advancement will not improve.

Highlights:

  1. Forehead bossing is treated by bony reduction of forehead width and projection. (forehead contouring)
  2. Vertical forehead reduction is a soft tissue procedure where hairline advancement is done. (scalp advancement)
  3. Total forehead reduction is when both bony and soft tissue procedures are done simultaneously.

Dr. Barry Eppley

Indianapolis, Indiana


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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