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Posts Tagged ‘brow bone reduction’

Technical Strategies – Brow Bone Fixation with Microplates and Screws

Saturday, September 26th, 2015


Brow bone reduction surgery is often done either for men with extreme prominences or as part of facial feminization surgery. The brow bones can be reduced by two basic methods, bone burring or an osteotomized bone flap. The thickness of the anterior frontal sinus wall and how much brow bone reduction is needed will determine what is the best technique for the patient.

Brow Bone Thockness X-Ray Dr Barry Eppley IndianapolisBut for very prominent brow bones a frontal sinus wall setback technique is needed. Known as an osteoplastic bone flap method, it is done by removing the entire frontal sinus wall by sawing it off flush with the surrounding forehead bone. This exposes some or all of the underlying frontal sinus cavities. Sometimes the mucosal lining can be kept intact if it is carefully peeled off the cut bone segment. The removed bone segments are rehaping, usually thinning them out so a flat piece is obtained, and then put back.

Putting the frontal sinus bone flap back requires that it be fixed to the underlying and surrounding bone. A stable bone segment will permit a good seal over the frontal sinuses (to prevent a postoperative air leak) and will allow for bone consolidation/healing. Multiple methods of brow bone fixation have been used from resorbable sutures, wire ligature and various sizes of metal plates and screws. Depending on the shape of the repositioned bone segment and how it fits into the surrounding bone, any of these bone fixation methods can work. The most stable method is always going to be plate and screw fixation as it is anywhere else on the craniomaxillofacial skeleton. But the plates and screws need ti be fairly small so that their profile does not eventually show through the forehead skin.

Microplate Fixation Brow Bone Reduction Dr Barry Eppley IndianapolisMicroplate Fixation Brow Bone Reduction Indianapolis Dr Barry EppleyMicroplate and screw fixation is ideal for the brow bones. With screws that are just 1mm in size and plate profiles that also sit no higher than 1mm, they provide firm fixation with negligible prominence. They can be used to piece together small bone fragments to securely cover the exposed frontal sinus. The length of the screws need to be no longer than 4mms to just enter the outer cortex of the forehead bone.

Brow bone fixation with microplates and screws works well but has only one minor drawback…cost. Such fixation will always be more expensive than that of sutures or even large plates and screws.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Tail of Brow Bone Reduction

Wednesday, September 23rd, 2015


Background: Reduction or augmentation of the brow bones is typically thought of as a horizontal change in their prominence. Such movements create more or less of a brow bone prominence most easily seen and appreciated in a lateral or side view. Such degrees of horizontal brow bone prominence is very gender-specific and is the motivation for much of aesthetic brow bone surgery.

brow bone orbital rim anatomyOne dimension of the brow bone or supraorbital rims that is rarely discussed is that of its lower edge. This dimension of the tail of the brow bone has an influence on eye shape affecting the position of the eyebrow and the fullness of the supratarsal fold. Eye asymmetry can result from differences in the position of the lateral brow bone edge. Low bony rims can also close down the eye and make contribute to upper eyelid heaviness/fullness.

The anatomy of the lateral brow bone is very simple. In this area of the brow bone there is no frontal sinus and the bone is very thick before entering the intracranial space. The only piece of relevant anatomy is that of the lacrimal gland. It is just under the tail of the brow bone in the lacrimal fossa.

Case Study: This 56 year old female had lifelong eye asymmetry. Her right upper eyelid was fuller than that of the left and she felt that the bone was pressing down on the eyelid. By feel the tail of the brow bone on the right side was lower.

Transpalpebral Brow Bone Reduction Technique Burring Reduction Dr Barry Eppley IndianapolisUnder general anesthesia, an upper blepharoplasty incision was made and dissection done under the orbicularis muscle up to the outer brow bone. The soft tissues were elevated and 5mms of the lower edge of the tail of the brow bone was removed with a handpiece and burr in a 9 to 1:00 o’clock span. The superolateral orbital soft tissues were suspended back up to the periosteum on the anterior face of the brow bone.

Transpalpebral Orbital Rim Contouring Right Eye result front view Dr Barry Eppley IndianapolisTranspalpebral Orbital Rim Contouring Right Eye result side view Dr Barry Eppley IndianapolisHer results show improved eye symmetry with a more open upper outer area of the right eye. She has no numbness or motion difficulties with the eyelid during blinking. The blepharoplasty incision healed imperceptibly.

The lower edge of the outer brow bone can be contoured/vertically reduced to create a more open eye or correct eye asymmetry. It is safe, causes no orbicularis muscle motion problems and can be done through the well known upper blepharoplasty incision.


1) Brow bone reduction can be done on the inferior outer edge for brow asymmetry or to open up the outer aspect of the upper eye.

2) Inferior brow bone reduction can be done through an upper blepharoplasty incision.

3) Resuspension of the stripped soft tissues is important when reducing the lower edge of the supraorbital rim.

Dr. Barry Eppley

Indianapolis, Indiana

Forehead Feminization Surgical Techniques

Tuesday, September 15th, 2015


Forehead feminization Surgery Dr Barry Eppley IndianapolisOne of the many important areas to change in facial feminization surgery (FFS) is that of the forehead. The typical male forehead has a prominent brow bone, a visible brow bone break into the upper forehead and a central forehead area that is often flat or even slopes backward to some degree. This is a major phenotypic difference from that of a female forehead who has or desires a rounder smoother and more vertically oriented forehead.

The cornerstone of a male to female forehead shape change begins at the brow bones. While the brow bones can have variable thicknesses before entering the underlying frontal sinus, simple burring down of the brow bones is minimally effective and inadequate for many patients. It may be useful when there is little brow bone protrusion or the outer table of the frontal sinus is very thick. (thus the importance of preoperative x-rays)

Transgender Brow Bone Reduction technique intraop 2 Dr Barry Eppley IndianapolisTransgender Brow Bone Reduction technique intraop 3 Dr Barry Eppley IndianapolisBut the most consistent and effective technique for brow bone reduction is that of the osteoplastic bone flap. Also known as the frontal sinus setback procedure the outer table of the frontal sinus (brow bone) is removed and reshaped. When the bone is replaced, which is necessary to cover the exposed frontal sinus cavity, it is put back so the brow bone contour is flatter. The much smaller segments of bone are usually best secured by small titanium microplates and screws. (1mm is thickness) The tail of the brow bones also needs to be reduced to create more of a lateral reduction and upward swoop. This can be done by bone burring since there is no underlying frontal sinus in this portion of the brow bone.

Transgender Brow Bone Reduction Forehead Augmentation intraop 1 Dr Barry Eppley IndianapolisTransgender Brow Bone Reduction Forehead Augmentation intraop 2 Dr Barry Eppley IndianapolisBut reduction of the brow bones alone is often insufficient to create a more optimal female forehead shape. The central portion of the forehead also needs to be augmented to create a more vertical forehead inclination and a rounder shape from side to side between the temporal lines. Various bone cements can be used and both PMMA and hydroxyapatite compositions are effective. The optimal choice is, however, hydroxyapatite cement due to direct bonding to the bone without a scar interface due to its calcium phosphate composition.

Combining flattening of the inner half of the prominent brow bones, reduction of the outer or tail of the brow bones and increasing the convexity and vertical slop of the forehead are all important forehead feminization techniques. In some cases a hairline advancement to shorten a vertically long forehead can also be done at the same time tio provide the most complete forehead shape change.

Dr. Barry Eppley

Indianapolis, Indiana

Technical Strategies – Transpalpebral Brow Bone Reduction

Sunday, July 12th, 2015


Brow Bones and Orbital RimsBrow bone reduction is one of numerous types of facial bone reshaping procedures. In its most traditional sense it is done to reduce the horizontal or forward projection of the brow bones. In essence this is to reduce the bulge or outward prominence of them. This is usually done either in men with very large and overgrown frontal sinuses or in male to female transgender surgery to create a perfectly flat brow bone arch. Depending upon the degree of brow bone protrusion and the thickness of the anterior wall of the frontal sinus burring reduction or an osteoplastic bone flap setback procedure can be done.

But excessive brow bone growth or shape can occur in other dimensions as well. Brow bones that are too vertically low or high can cause undesired orbital/eye issues. Brow bones that are too high (increased vertical orbital height) may make the eye look too open and the brows retracted. Brow bones whose edges are too vertically low may make the eye look too closed or push down on the eyelid tissues causing an appearance of eyelid hooding or pseudoptosis.

Transpalpebral Brow Bone Reduction Technique Surgical Exposure Dr Barry Eppley IndianapolisLike horizontal reduction of the brow bones, vertical reduction of them can also be done. This is often combined with horizontal reduction particularly in transgender brow/orbital bone reshaping through a coronal scalp incision. But there are cases when only a vertical brow bone reduction is needed which is usually when it is causing a more ‘closed eye’ appearance or eyelid asymmetry. Rather than using a scalp incision, isolated vertical or tail of the brow bone reduction can be done through an upper eyelid or transpalpebral incisional approach. This direct access allows for a limited dissection technique that more easily isolates the desired brow bone location.

Transpalpebral Brow Bone Reduction Technique Burring Reduction Dr Barry Eppley IndianapolisTranspalpebral brow bone reduction is limited in that it can not reach the more medial part of the brow bone due to the location of the supraorbital nerves. But for tail of the brow bone reshaping or pure vertical reduction of the supraorbital rim, an eyelid incision is more appealing than the ‘far away’ and more extensive coronal incisional approach.

Dr. Barry Eppley

Indianapolis, Indiana

Brow Bone Reduction with Mid Forehead Nerve Sparing Technique

Wednesday, May 13th, 2015


Excessive brow bone protrusion, known as brow bone hypertrophy, is a well recognized phenomenon that is due to over pneumatization of the frontal sinus. While many people think that it is due to excessive bone growth, it is actually due to an over enlargement of the frontal sinus air cavity. This pushes out the air cells making the brow bone and lower forehead look like a ‘bubble’ is sticking out from the bone. It can occur in different patterns from a large horizontally protruding brow bone across the top of the eyes to extensions up further up and out from the brow bone. It is a forehead growth pattern that is seen almost exclusively in men.

Male Brow Bone Reduction Dr Barry Eppley IndianapolisThe approaches to brow bone reduction are fundamentally two-fold, either burr the brow bone down or remove the outer cortex of the brow bone and completely reshape and re-insert it. In men with any significant amount of brow bone protrusion, the bone removal/reshaping approach (osteoplastic flap method) is the one that is most effective and will make the greatest difference. The success of bone burring is limited by the thickness of the outer bony cortex of the frontal sinus which is usually only a few  millimeters.

The real issue in male brow bone reduction surgery is not the method to do it but the surgical access. Because any form of effective brow bone reduction requires open exposure an incisional access is needed. Typically this is done from a coronal or scalp incision and if one has a good hair density this would be the preferred placement of the incision. But for men with thin hair or who shave their head a coronal incision may not be aesthetically acceptable. This leaves the alternative option of a forehead incision through an existing horizontal wrinkle line.

Supraorbital NerveA mid-forehead approach provides direct access to the brow bones and involves far less tissue dissection than that of the more traditional coronal scalp incision. It requires one to have an existing horizontal wrinkle line which is preferable to get the best scar outcome. But besides the scar the other aesthetic trade-off would be a high likelihood of permanent forehead and anterior scalp numbness. The mid-forehead horizontal incision will directly transect the branches of the supraorbital and supratrochelar nerves that run vertically up the forehead from their exit from the bony foramen usually located on the bottom of the brow bones. While this does not affect movement of the forehead since these are sensory nerves, permanent numbness could be a bothersome long-term issue.

Nerve Sparing Brow Bone Reduction Dr Barry Eppley IndianapolisBone Flap Removal in Nerve Sparing Brow Reduction Technique Dr Barry Eppley IndianapolisBone Flap Fixation Nerve Sparing Brow Bone Reduction Technique Dr Barry Eppley IndianapolisA nerve sparing technique can be used with the horizontal forehead incisional approach to the brow bones. After the skin incisions the vertical nerve branches are dissected out and spared. The brow bone surgery is then done by working underneath them. The brow bone flap is removed, reshaped, resinserted and then rigidly fixed, all while working in and around the spared nerve fibers. The incision is closed in layers with care taken to not inadvertently entrap the nerve branches in the sutures.

Mid-Forehead Brow Bone Rerduction result intraop Dr Barry Eppley IndianapolisA nerve sparing forehead incision brow bone reduction technique can produce a very successful setback of the brow bones.  While the spared nerve branches do get stretched a little during the procedure they are more likely to allow a return of forehead feeling that if they were completely transected.

Dr. Barry Eppley

Indianapolis, Indiana


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

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


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

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

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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