The shape of the male forehead is distinctly different from that of the female. In addition to the inferior brow bone projections, it is broader, flatter and more vertically inclined in shape. It also has more distinct lateral temporal lines which is the transition between the bony forehead and the temporal soft tissues. Given that the forehead occupies one-third of the surface area of the visible face, it makes a significant contribution to the overall male facial appearance.
A round narrow forehead is a weaker male feature than some elect to change. The ability to do so with injectable strategies such as synthetic fillers and fat is very limited given their softer compositions and inability to make angular or more defined transitional changes. Bone cements are also inadequate, not only because of the need for a long open incisional approach to place them, but because of their inability to be placed beyond the lateral temporal lines onto the soft tissues.
When it comes to creating an improved angularity and shape to the male forehead, which almost always requires widening, the only predictable approach is with a custom designed implant. There are many different styles of male forehead implants but a most unique one is the forehead-temporal widening design. This is indicated when one has a narrow skull shape with a resultant narrow forehead. What is most needed is an increase in forehead width with a more visible lateral temporal line transition. In these patients the rest of the forehead may be fine with good brow bone shape and an adequate vertical slope but it is too narrow and the temporal line is rounded and more indistinct.
This non-traditional custom forehead implant does not cross the center or meet in the middle but is a paired or bilateral design. Because the overall skull is narrow the design extends back along the entire temporal line for an upper temporal skull augmentation effect as well. It does not extend too far inferiorly into the anterior and posterior temporal areas because the goal is not an overall temporal augmentation. Rather it is to create more of an anterior temporal hollowing effect which further highlights the enhanced temporal line of the forehead and skull.
This is a type of forehead enhancing implant that needs to be placed on top of the deep temporal fascia. Because its main effect is along the temporal line it must sit on the bony forehead centrally and the deep temporal fascia laterally. This is a dissection which can almost be completely done from a postauricular incision. The dissection is aided by two very small scalp incisions in the frontal and parietal area to ensure the continuity of the created pocket as well as to secure the implant. An endoscope can be used for the bony forehead dissection but this is usually only necessary if the implant design completely covers the brow bone areas. One must be aware of the location of the frontal branch of the facial nerve and the superficial temporal artery which runs immediately above the dissection plane in the intermediate temporal fascia.
Such a large surface area implant can remarkably be inserted through the hidden incision behind the ear. It is done so in a rolled fashion and then unraveled and positioned once inside the pocket. The additional two very small scalp incisions allow for three-directional access for pocket dissection, implant unraveling and positioning and two point microscrew fixation.
Dr. Barry Eppley
Indianapolis, Indiana Custom