Brow Bone Augmentation
Brow bone prominences with a suprabrow bone break are the hallmark of a masculine upper third of the face. Men always have some semblance of brow bone prominences while the vast majority of women do not. In the past, the typical surgical approach has been the application of bone cements or a hand made implant material through an open coronal scalp incision placed behind the hairline. This approach is fraught with potential brow bone shape/irregularity issues not to mention the long scalp scar needed to place them. I now consider this an historic approach with significant aesthetic liabilities..
The contemporary and far more effective technique is to use a custom brow bone implant made from the patient’s 3D CT scan. The presurgical design process allows for the exact amount of increased brow bone prominence, its shape and complex topography across the glabellar area as well as how far it extends down along the lateral orbital rim. While it may appear on a cursory glance that the brow bone is a horizontal straight bar of bone across the top of the eyes, this is far too simplistic design approach. It actually has one of the most complex 3D shapes of any bone on the face due primarily to the frontal sinus cavities which comprise the central region. Getting the ‘eagle wing’ shape of the brow bones and transitioning that into the lateral brow is an art form onto itself.
The brow bone implant can be placed using an endoscopic approach through a small scalp incision which may or may not need to be aided by small lateral upper eyelid incisions. (depending upon how far down along the lateral orbital rims the implant design goes)
Such brow bone implants can be done alone if one has an adequate forehead shape above it.
The shape of the male forehead is less rounded and vertically inclined than that of the female. For the female to male patient the vertical inclination of the forehead may be satisfactory but it may have inadequate width and lacks a slightly flatter/broader/shape. This really has to do with the location of the bony temporal lines which are the lateral transition points of the bony forehead to the soft tissue temporal area. Women typically lack them due to their convex forehead shapes while their presence in men is more visible. Besides the presence of brow bones this is a defining feature of the male forehead.
Creating a more masculine forehead shape involves broadening the bony lateral borders of the forehead over onto the temporalis fascia to create the needed width. When the shape change is combined with the large surface area of the forehead and creating a completely smooth surface, the best approach is a custom forehead implant design. This also has the added advantage of a much smaller scalp incision for placement. Bone cements can be used but requires a more open approach with longer scalp incisions and relies on the intraoperative artistic shaping of a moldable bone cement material.
Forehead-Brow Bone Augmentation
Depending upon how deficient the upper third of the face is, a combined forehead-brow bone implant may be beneficial. This has the most transformative effect as it completely changes the shape of the forehead in a controlled manner in a single implant design. It is the only facial reshaping procedure in which an entire third of the face is altered in its entirety by one single implant.
Dr. Barry Eppley