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Posts Tagged ‘custom forehead implant’

Technical Strategies – Endoscopic Custom Forehead Implant Placement

Monday, November 30th, 2015


Forehead Implant Design Dr Barry Eppley IndianapolisAesthetic forehead augmentation to correct a sloped, irregular or deficient frontal bone can be done by a variety of materials placed on top of the bone. Having used every one of them, they each have their merits and each material type can be successfully used in experienced hands. But the forehead augmentation method that has the best results is that of a custom forehead implant.

Endoscopic Custom Forehead Implant incision Dr Barry Eppley IndianapolisBesides being able to create the exact shape and thickness desired before surgery, a preformed custom forehead implant can also be inserted through the smallest scalp incision. While the use of bone cements require a full coronal incision to be placed in most cases, a custom forehead implant can be inserted through an incision that is limited to between the bony temporal lines. This avoids extending the incision onto the temporal area on the sides of the head where the scar can be more easily detected and always gets wider than that across the top of the head.

Endoscopic Custom Forehead Implant positioning Dr Barry Eppley IndianapolisThe biggest concern about placing a custom forehead implant is to get it low enough over the brow bones if that is the way it was designed. Placing a forehead implant that does not involve the brow bones is far easier and adequate positioning is almost never an issue.   But placing a complete custom forehead implant that must go over the brow bones first requires a subperiosteal release and supraorbital nerve dissection. This must be done with an endoscope given the limited size of the scalp incision. Once the forehead implant is inserted checking its placement with an endoscope can also be done.

The use of the endoscopic technique in a custom forehead implant is to ensure as best as possible the extent of the subperiosteal pocket and protection of the supraorbital nerves. It is not used because it can limit the extent of the scalp incision like is done is more traditional endoscopic browlift surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Case Study – Custom Forehead Implant for Central Depression

Thursday, February 19th, 2015


Background: The shape of the forehead is well known to be gender-specific. Women usually prefer smooth convex foreheads with no obvious brow bone prominences. Conversely, men usually desire evidence of a brow bone with a break into the mid-forehead with a more retroclined  shape into the upper forehead. While I have seen males and females cross these classic forehead shape differences with iterations in between, these general preferences remain.

Male Forehead Shape Dr Barry Eppley IndianapolisThe male forehead shape is more ‘complex’ than that of the female. With brow bone prominences that stick out further than the central forehead, combined with a slight glabellar indentation, the male forehead has more subtleties in its shape. Changes in these subtleties can result in aesthetic imbalances that cast shadows or create undesired profiles.

When men have too much brow bone protrusion it can make the mid- to upper forehead look too far back. Conversely, a recessed forehead can make the brow bones look like they are too big. This is an important distinction to make as the treatment approaches to either one are very different. Computer imaging can help make the diagnosis as to whether it is the forehead or the brow bones that are the source of the aesthetic concern.

Case Study: This middle-aged male did not like the shape of his forehead. He liked the amount of brow bone prominence that he had but felt the central forehead directly above it was too recessed. This created an unaesthetic shadowing which he desired to be improved/eliminated.

Custom Central Forehead Implant Design Dr Barry Eppley IndianapolisUsing a 3D CT scan, a custom forehead implant was made to fill in the central depression. Its shape had an extension that went into the glabellar indentation and it blended into all the other forehead area with a fine edge taper. (< 1mm) Its greatest thickness at its midportion was 4mms.

Custom Central Forehead Implant desigtn and locationUnder general anesthesia, a small zig zag incision (3cms) was made between the hairs just behind the frontal hairline.  A subperiosteal pocket was developed through this incision, taking it just to the limits of the presurgical marks on the forehead. The custom implant was prepared by making five 2mm holes through the implant. (perfusion/fixation holes) The implant was easily inserted, positioned and the scalp skin closed with resorbable sutures.

Custom Central Forehead implant intraop side view Dr Barry Eppley IndianapolisWhile the type of custom implant is small, it is the most accurate method to create a smooth central forehead augmentation. Other methods of forehead augmentation exist, such as bone cements, but they require longer incisions to insert and the risk of edge transition visibility/palpability is higher.

Case Highlights:

1) Forehead depressions and contour irregularities require bone augmentation.

2) The simplest and most reliable form of forehead contour augmentation is with the use of a custom forehead implant which can be done through the smallest incision and the least invasive procedure.

3) ‘Prominent’ brow bones in men can be artificial as the real bony problem is a backward forehead slope or depression above the brow bones.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Custom Male Forehead Implant

Thursday, July 31st, 2014


Male Forehead Surgery Dr Barry Eppley IndianapolisBackground: The male forehead is uniquely different from that of females. It has more prominent brow bones, a well defined brow break and a forehead that has no more than 10 to 20 degree angulation backward into the frontal hairline superiorly. This is quite different from a female’s forehead which ideally has little to no brow prominence and a more vertical and convex forehead shape.

Forehead augmentation is less common in men than females. Usually most men who present for aesthetic forehead surgery have brow bones that are too prominent and they want them reduced. But occasionally a man may want a more masculine forehead shape that has the aforementioned male forehead features as well as some increased width.

Traditionally, reshaping a forehead using an augmentation method has been done using bone cements. Through a full coronal incision, the bone cement is mixed, applied and shaped through wide open exposure. This allows for the best shape creation and to eliminate the risk of any edge or transitional material concerns into the surrounding tissues. But such hand shaping must rely on the surgeon’s skill and experience at creating the desired forehead shape.

Custom Forehead Implant Design Dr Barry Eppley IndianapolisCase Study: This 28 year-old male wanted a masculine forehead shape. He desired the classic male forehead features with more brow bone protrusion, a brow bone break and less vertical angulation upward. His present forehead had minimal brow bones and a very retroclined forehead slope. Using a 3D CT scan, a one-piece forehead implant was designed with the requisite features.

Custom Forehead Implant result side view Dr Barry Eppley IndianapolisUnder general anesthesia, a limited coronal scalp incision was made well behind his existing hairline with no shaving of hair. Subperiosteal elevation was done down to the brow ridges with release of the periosteum. Dissection was carried out onto the deep temporal fascia. The custom implant was inserted, seated and secured into position along its upper edge with three small self-drilling titanium screws. The scalp incision was closed in layers with dissolvable sutures.

Custom Forehead Implant result oblique view Dr Barry Eppley IndianapolisA custom forehead implant is an ideal method to get the best fit and shape for an augmentation effect. It also makes the operation take less time which nearly offsets the increased cost of making the custom implant. A somewhat smaller scalp incision can also be used. In addition with a more assured aesthetic outcome the risk of revisional surgery is also lessened.

The use of custom implants for the craniofacial area continues to grow and expand and its use in the forehead represents another example of its growing role in aesthetic facial surgery.

Case Highlights:

1) Forehead augmentation in men is designed to increase the prominence of the brows and decrease the posterior angulation of the forehead.

2) Forehead augmentation can be done using either intraoperatively applied bone cement or preformed custom implants.

3) Forehead augmentation with custom implants made from the patient’s 3D CT scan provides an optimal fit to the bone and the best smoothness and symmetry in the implant’s shape.

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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