Brow bone augmentation can be done using a variety of techniques and materials. The most common approach has been an open scalp or hairline incision using bone cements to do the buildup of the brow bones. While effective it does necessitate a long incision that is fairly distant from the implantation site and the final shape of the result depends on the surgeon’s artistic shaping skill during surgery.
Another approach is to place a brow bone implant that is premade from a 3D CT scan. This has a lot of advantages in that the implant design is predetermined before surgery and its placement can be done through a much more limited incisional method. An endoscopic technique can be done using two small paired hairline (or just behind the hairline) incisions. The subperiosteal pocket is developed under endoscopic visualization and the brow bone implant is inserted through one of the incisions.
The implant is then positioned and secured, if needed, with small screws using a percutaneous technique. Even though the implant has a custom fit, keeping it from sliding upward is important since most brow bone implants need to sit as long as possible particularly in the male patient. This is a brow procedure that takes only about an hour to complete.
The hairline incisions offer a very direct approach to the brow bones. Some patients understandably may find these incisions and their resultant scars as potentially problematic. But it has been my experience that these hairline scars in the male patient do well and blend in inconspicuously. It is their irregular zigzag pattern that allows them to heal well as a straight line incision would be more noticeable.
Dr. Barry Eppley