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Posts Tagged ‘female forehead augmentation’

Female Forehead Augmentation

Tuesday, May 3rd, 2016

 

Female Forehead Augmentation  Surgery Dr Barry Eppley IndianapolisThere are numerous gender differences in the shape of the female and the male face and the forehead is no exception. In fact the forehead can be one of the most significant gender markers. This is seen in the prominence of the brow bone in men and the suprabrow bone break that women don’t (or should not) have. Females should have no visible brow bossing with an overall forehead shape that is more rounded (convex) and a fairly flat (vertical) side profile. While men can have some backward sloping to their forehead, this is not aesthetically pleasing in women.

In female forehead augmentation, one has to have a good knowledge of how to shape the forehead and the materials that can be used to do it. I have used every available implant material that is known to exist for forehead augmentation including numerous types of bone cements and standard and custom made implants.

Female Forehead Augmentation intraop above view Dr Barry Eppley IndianapolisFemale Forehead Augmentation result intraop side view Dr Barry Eppley IndianapolisWhile most of these materials can be used to create a satisfactory forehead augmentation,  none of them are perfect. The most commonly used of these materials is PMMA bone cement because of its ease of use and economical cost. While it takes experience to use it effectively, it allows good working time but comes to a fast set after it is contoured. It can be impregnated with antibiotics for a sustained release from the material for weeks after its implantation. Like all bone cement materials it require a fairly open incision to accurately place if the entire forehead needs to be contoured.

Asian Forehead Augmentation result side view Dr Barry Eppley IndianapolisFemale Forehead Augmentation  result side view Dr Barry Eppley IndianapolisThere are several surgical caveats with its use in female forehead augmentation. It is important to not over augment the forehead particularly in forward projection. Some convexity is needed but one does not want to end up with an overall frontal bossing effect. While its intraoperative application is an artistic judgment, when in doubt less is more so to speak. The goal is more of a completely flat and more vertical forehead.

To avoid too wide of a forehead, it is important to keep the cement application inside the anterior temporal lines. The augmentation should generally not spill over onto the temporalis muscle/fascia. If it does there is some risk of causing discomfort with cement edges on the soft tissues of the muscle.

Female forehead augmentation with PMMA bone cement can done successfully with a low risk of revision if the aesthetic goals are understood and the material is applied following these principles.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Female Forehead Augmentation

Thursday, September 17th, 2015

 

Forehead feminization Surgery Dr Barry Eppley IndianapolisBackground: Like the rest of the face, the appearance of the forehead is very gender specific. A female forehead usually has three specific components to it. First there is no perceptible brow bone ridge or brow bone break into the forehead. It is smooth as it ascends from the supraorbital rims into the upper forehead. Secondly, this ascension upward has more of a vertical orientation and not a backwards sloping or anterior protrusion profile to it. Lastly, there is an overall convex shape that is more full centrally and tapers into the temporal regions.

Female forehead augmentation can be done using a variety of different materials from bone cements to preformed and custom silicone implants. The choice of which material method to use depends on a variety of factors not the least of which is the amount of augmentation needed and the type of incisional approach to be used. With a completely open approach to forehead augmentation a viable option is that of bone cements. Such visual access allows for good cement application and shaping which is a critical part of intraoperatively applied onlay materials.

Before custom forehead implants became a treatment option, the gold standard for female forehead augmentation was the use of PMMA bone cements. This is still a useful material choice but does require a scalp incision of some length. A hairline or pretrichial incision can be used if one is also moving the hairline or one can tolerate the location of the scar. The further back in the hairline one goes the longer the scalp incision must be to provide adequate access for cement application and shaping.

Case Study: This 25 year old female wanted to create a better forehead shape. She felt her forehead sloped back too far and wanted more projection, particularly in the central part of the forehead. She already had a coronal scalp incision/scar from a prior procedure.

Female Forehead Augmentation with PMMA Bone Cement intraop Dr Barry Eppley IndianapolisUnder general anesthesia, her coronal incision was reopened and a complete forehead flap developed down to the brows. Sixty (60) grams of PMMA bone cement was prepared with antibiotic powder to create a putty. The PMMA putty was applied to the forehead and shaped by using the forehead flap to spread it out evenly over the forehead until it set. Once set final shaping and smoothing of the edges was done by a handpiece and burr.

Female Forehead Augmentation result side view Dr Barry Eppley IndianapolisFemale Forehead Augmentation result oblique view Dr Barry Eppley IndianapolisFemale forehead augmentation can be successfully done using PMMS bone cement. The material offers a permanent and smooth solution to reshaping the contours of the forehead. A longer scalp incision is usually needed to assure smooth edges. Most females do not need large volumes of material and usually 60 grams of PMMS material are adequate.

Highlights:

1) The ideal shape of the female forehead is that of a more convex shape without brow bone prominences and a near vertical orientation.

2) Female forehead augmentation can be done using bone cements but require a more open scalp incisional approach to do so.

3) A coronal scalp approach to a female forehead augmentation is best reserved for those women having  other skull procedures or who already have a full coronal scalp scar.

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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