A more prominent brow bone is an almost exclusive male aesthetic feature. While all men have some semblance of a brow bone, some are less defined due to lack of frontal sinus development than others. There are no preformed brow bone implants commercially available and making them by hand out of various materials works so poorly that only custom designed brow bone implant should be considered.
In designing a brow bone implant there are four important considerations.First, the location of the forward brow bone projection is lower than one thinks to get the desired aesthetic effect. It is a common misjudgment in placing the brow bone projection too high which creates an unnatural brow bone augmentation appearance. Second, the brow bone is not a simple even horizontal projection of bone across the lower forehead. It has a complex shape that should consist of an ‘eagle wing’ shape centrally over the frontal sinus areas and a separate ridge of projection over the lateral brow and into the upper lateral orbital rims. Third, the brow bone implant design must take into consideration the supraorbital nerve exit locations from the bone and make adequate nerve relief is made into the design. Lastly, natural brow bone break must be created into the implant so it flows smoothly into the upper forehead.
Placement of a custom brow bone implant is done through a small scalp incision that is far smaller than the width of the implant. An endoscopic technique is used to create the subperiosteal pocket over the brow bones and around the supraorbital nerves. Depending upon how far down the implant extends onto the lateral orbital rims the pocket may need to be extended under more direct vision through small lateral upper eyelid incisions. This allows for precise placement of the ‘wings’ of the brow bone implant which are the thinnest and easiest part of the implant to be malpositioned.
Dr. Barry Eppley