Background: 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.
Case 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.
Under 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.
A 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