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Technical Strategies – Frontal Sinus Obliteration Brow Bone Reduction

 

Brow bone reduction is a forehead reshaping procedure for both men and women. In men it is done to reduce an overly prominent brow bone appearance but yet maintain some accepted male brow bone presence. This almost always requires a setback bone flap technique. In some women it may be done to soften the brows and a successful result may come from a bone burring technique only.

In transgender male to female brow bone reduction, however, the goal is more aggressive with the objective of a complete elimination of any brow bone protrusion at all.  In making a male brow bone shape into a female appearance, the ultimate success is what happens at the frontonasal angle area. Inadequate reduction in this area mars many male to female conversions with a residual high radix and a very open nasofrontal angle. This fails to create a visible lessening of the frontonasal angle that is closer to the projection of the eye. This is the result of inadequate bone reduction at the lower end of brow bone just above the frontonasal angle. It also is contributed to by inadequate reduction of the height of the nasal bones which creates the lower line of this angle.

Getting the brow bone flap set back far enough can almost always be done by bone manipulation (reduction) alone. With the bone flap removed the height of the frontonasal angle can be directly reduced by burring before putting the bone flap back. But when this method fails or a patient desires maximal brow bone reduction beyond what a bone flap technique will allow, there is an alternative strategy.

Maximal reduction of the brow bones and height of the frontonasal angle can be done by a frontal sinus obliteration technique. In this method the brow bone flap is removed and not put back. Rather the frontal sinus lining is removed, the bone flap used to graft the frontonasal ducts and hydroxyapatite cement placed to fill in/obliterate the complete frontal sinus cavities. This removes the last bony obstruction for maximal setback and opening up of the frontonasal angle.

In this frontal sinus obliteration technique it is important to later in the hydroxyapatite cement and compressed packing to be sure all air spaces of the sinus are completely filled.

Frontal sinus obliteration is not a standard technique in brow bone reduction and is usually only used in the rare event of chronic frontal sinusitis/bone flap osteomyelitis. But when maximal brow bone reduction is desired or as a secondary reduction method when the first is inadequate, it offers a highly effective reduction contouring method.

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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