Background: 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.
Under 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 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