Background: The shape of the forehead in men is determined by the prominence of the brow bones and the slope and width of the forehead above it. Most men have some degree of brow bone protrusion as evidenced by the presence of a brow bone break before going up into the forehead. How protrusive the brow bones need to be before becoming an aesthetic concern is a matter of personal judgment. In very large brow bones, which have an almost Neanderthal appearance, that judgment is easy.
But some men have more moderately-sized brow bones and the decision to do a formal brow bone reduction may seem excessive or undesired. In these cases it is important to look at computer imaging and see how a forehead augmentation compares and contrasts to that of a brow bone reduction. By doing so the patient can make the determination as to which approach looks best to them….brow bone reduction, forehead augmentation os some combination of both.
Forehead augmentation, by definition, makes the brow bones look less prominent as the slope and fullness of the forehead above them becomes filled in. The more the forehead slopes changed to increased verticality, the more proportionate the forehead shape becomes and the brow bone prominence becomes more normal. Forehead augmentation can be done by the intraoperative application and shaping of bone cements or the prefabrication and insertion of a custom forehead implant.
Case Study: This young male was bothered by the shape of his forehead, focusing on his larger brow bone prominences. Computer imaging was done to compare brow bone reduction vs forehead augmentation…of which he opted for the latter.
Under general anesthesia and through a limited frontal scalp incision a subperiosteal pocket was created down to the brow bones and then up along the lateral temporal lines. Using 60 grams of PMMA bone cement mixed with antibiotic powder, a putty consistency was obtained and inserted onto the forehead bone. Using external molding through the outside of the scalp, the desire forehead shape was created.
His long-term postoperative result (3 years) shows a symmetric and nicely shaped forehead that eliminated the initial concerns about the prominent brow bones. A forehead augmentation in moderately enlarged brow bones keeps the forehead with a masculine appearance.
A custom forehead implant made from the patient’s 3D CT scan its always the best method to do forehead augmentation. Working with bone cements through a very limited scalp incision is challenging to achieve the same smooth and evenly contoured shape as that of an implant.
Highlights:
1) The diagnosis of prominent brow bones in a male must also consider the shape of the forehead above it.
2) Preoperative computer imaging can help the patient make the determination between the need for a brow bone reduction, forehead augmentation or some combination of both.
3) Forehead augmentation can be done using either bone cement or a custom forehead implant above the brow bones back into the frontal hairline.
Dr. Barry Eppley
Indianapolis, Indiana