The forehead occupies one-third of the surface area of the face so it no surprise that it has an influence on the shape and appearance of the face. The movement of the eyebrows and the forehead wrinkles that it creates allows for a lot of expression to be seen even though at rest it is a just a flat surface.
One of the important features of the forehead is its slope or angulation. What is its angle from the eyebrows back to the frontal hairline. (or where the hairline might have been) It is commonly stated that men have more a more backward slope to their forehead than women. An attractive forehead slope in a female is much more vertical. These aesthetic forehead standards can be debated but each person’s individual preference is all that really matters.
Whether it be male or female, the best method of decreasing the slope of the forehead is a custom forehead implant. It is not usually necessary to cover the brow bones and doing so is usually counterproductive to decreasing the slope of the forehead. The implant stays above the brow bones and extends to the side to the edge of the temporal line at the side of the forehead. It will always extend further behind the frontal hairline by a few centimeters.
The key to the forehead implant design is how much to increase the projection of the implant. Rather than look at millimeters of projection, it is equally important to look at the change in angulation. Using the natural slope of the forehead seen in profile as the base, an increase in angulation of 10 to 15 degrees is aesthetically acceptable for good augmentation and this usually means a 5mm to 6mm thickness of the implant at the upper forehead. Greater amounts of increased verticality can be done with a 15 to 20 degree change. But one must be careful to not try and overprotect the central forehead given the the width of the implant is limited to the lateral temporal lines. When the height to base ratio becomes excessive it can create a frontal bossing appearance.
Men can have the implant designed so it is more square shaped through an increase in he projection at the lateral temporal lines. Women keep a rounded or more convex shape by tapering the implant don to a feather edge at the temporal lines.
The custom forehead implant can be placed through a small scalp incision several centimeters behind the hairline. Depending on the thickness of the implant the inions length can be anywhere from 6 cm to 10 cms. Once the implant is inserted and positioned, it is secured in place with two microscrews to allow a stable position while healing.
The custom forehead implant provides the best method to ensure shape and smoothness to decrease the slope of the forehead. It is a far superior approach to the traditional use of bone cements with the need for a much smaller scalp incision for insertion and greater assurance of a smooth shape that creates the desired change in forehead angulation.
Dr. Barry Eppley
Indianapolis, Indiana