There are numerous gender differences in the shape of the female and the male face and the forehead is no exception. In fact the forehead can be one of the most significant gender markers. This is seen in the prominence of the brow bone in men and the suprabrow bone break that women don’t (or should not) have. Females should have no visible brow bossing with an overall forehead shape that is more rounded (convex) and a fairly flat (vertical) side profile. While men can have some backward sloping to their forehead, this is not aesthetically pleasing in women.
In female forehead augmentation, one has to have a good knowledge of how to shape the forehead and the materials that can be used to do it. I have used every available implant material that is known to exist for forehead augmentation including numerous types of bone cements and standard and custom made implants.
While most of these materials can be used to create a satisfactory forehead augmentation, none of them are perfect. The most commonly used of these materials is PMMA bone cement because of its ease of use and economical cost. While it takes experience to use it effectively, it allows good working time but comes to a fast set after it is contoured. It can be impregnated with antibiotics for a sustained release from the material for weeks after its implantation. Like all bone cement materials it require a fairly open incision to accurately place if the entire forehead needs to be contoured.
There are several surgical caveats with its use in female forehead augmentation. It is important to not over augment the forehead particularly in forward projection. Some convexity is needed but one does not want to end up with an overall frontal bossing effect. While its intraoperative application is an artistic judgment, when in doubt less is more so to speak. The goal is more of a completely flat and more vertical forehead.
To avoid too wide of a forehead, it is important to keep the cement application inside the anterior temporal lines. The augmentation should generally not spill over onto the temporalis muscle/fascia. If it does there is some risk of causing discomfort with cement edges on the soft tissues of the muscle.
Female forehead augmentation with PMMA bone cement can done successfully with a low risk of revision if the aesthetic goals are understood and the material is applied following these principles.
Dr. Barry Eppley
Indianapolis, Indiana