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Forehead augmentation in the male is distinctly different than that for females.The key differences are that men often need a concurrent brow bone augmentation and their foreheads are distinctly wider and less round than women. Women often want a more vertical forehead while men need to have a slight backward slope to it near the frontal hairline.

In designing male custom forehead implants these shape considerations must be incorporated into them. The first step is to determine whether the brow bone needs to be part of the implant. And if so how far down along the lateral orbital rim does it need to extend as well as centrally at the frontonasal junction. As a general rule there is rarely a need to pass the frontozygomatic suture line laterally or the frontonasal centrally. 

Cresting the brow bone shape and amount of projection needed is a learned art. I use a preformed eagle wing design that took a long time to determine how to replicate the exact topography that the medial and lateral brow bone prominences create. The frontal sinus projections are different than that of the lateral brow bone. 

How much brow bone projection needed will vary per each patient but 3 to 7mms is the typical range. (3mm is very modest while 7mm is aggressive) It is also important to establish the different projections across the brow bone as they can not all the exact same projection. The lateral brow will have slightly less projection than the medial brow with central slight glabellar dip or valley.

As the implant goes above the brow bones there should be a supra brow bone break which women do not have. As the implant heads to the frontal hairline any excessive backward slope is corrected by an increased thickness of material. If the upper forehead needs augmented the design must then head back behind the hairline for a natural smooth transition into the top of the skull.

The width of a male custom forehead implant design is critical and the implant design will almost always cross the bony temporal line onto the temporal muscle fascia. How far it goes onto the fascial depends on how much forehead width is desired. One of the major advantages of a custom forehead implant is the ability to cross over the bony temporal line…an augmentation feature that bone cements can not do very well. The added width of the design allows for the bony temporal line to be moved more laterally or accentuated with a greater ridge line. One should, however, avoid the temptation to make the bony temporal line too strong as this almost always ends up as unnatural in appearance.

Positioning the make custom forehead implant in surgery is a function of making sure it sits low enough on the brow bone. This is helped considerably by using an endoscopic visualized release along the supra- and lateral orbital rims. Brow bones that are sitting too high looks really unusual and every effort needs to be done to get it positioned as it was designed. This is more challenging when the implant drops down the level of the brow bones where it becomes even more important.

Dr. Barry Eppley

Indianapolis, Indiana

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