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While there are a large number of  implants available for aesthetic augmentation of the middle and lower face, the upper third of the face (forehead) has remained devoid of any such off the shelf option. Forehead bone augmentation have up to the present time only been available using injection materials,  bone cements or a custom forehead implant method. 

While the forehead can be augmented by injectable fillers it has to be repeated for maintenance of the effect. Fat injections can also be used but is unpredictable in terms of volume survival and contour shape and can be very difficult  to revise or remove it. Bone cements was an historically and proven method for forehead augmentation but requires a large scalp incision to place and a high level of surgical expertise to get it shaped properly. Custom forehead implants are the ideal approach and any degree of complexity, asymmetry or expanded footprint beyond the temporal lines makes their use mandatory. But in more modest forehead shape deficiencies it adds considerable cost to the surgery.

One of the most common aesthetic forehead shape concerns is in females. The most aesthetic forehead shape in women has a more vertically inclined forehead that has a rounder or more convex shape. Staying within the boundaries of the brow bones inferiorly, the frontal hairline superiorly and the temporal lines laterally the forehead shape can be augmented for increased roundness by a standard implant shape for a gradual to a more significant convex shape.

A new solid silicone implant is now available for forehead augmentation, specifically designed for females. Composed of a soft solid silicone material, it provides central forehead augmentation for an increased convex shape. Its greatest projection is in the center of the implant which gradually tapers down to paper thin edges at all of its perimeter edges. It has several thicknesses in which with increased thickness the footprint of the implant becomes greater. This prevents the augmentation effect from causing an undesired protrusive effect.

The forehead implant is placed in the subperiosteal plane of the forehead through a small central incision at or just behind the frontal hairline. The subperiosteal dissection to create the implant pocket is done with scalp elevators and does not require an endoscope to adequately complete it. The dissection goes down to but not onto or over the brow bone area. The implant is rolled for insertion and passed into the pocket pocket. Once inside the implant is unrolled and positioned over the central forehead. Once good position is obtained no screw fixation is needed. The scalp incision is closed with resorbable sutures and a circumferential head wrap applied.

Forehead implant augmentation is very straightforward procedure. The subperiosteal pocket dissection is rapid and risks no injury to any blood vessel or nerves. Some temporary forehead numbness is to be expected. There is mild swelling and usually little to no bruising after the procedure. Patients report very little postoperative discomfort afterwards. The head wrap is worn for 48 hours after the surgery in which it can be discarded thereafter.

The female forehead implant is now available to provide permanent bony augmentation for an enhanced convex shape. They can be used when either an injectable forehead  augmentation has failed or a more assured one-time permanent effect is desired. While the implants are soft and flexible it will create a firm and bony feel to the new forehead shape.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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