The shape and appearance of the forehead is highly influenced by the appearance of the brow bones. While usually taken for granted when they are normal, the brow bones or supraorbital rims serve as the roof/overhang of the eye. A strong or weak bony overhang influences the appearance of the eye as well as that of the overall face.
The appearance of the brow bones is very gender specific. Men naturally have stronger brow bones due to greater development of the frontal sinus cavity. This results in a brow protrusion and the creation of a suprabrow break above it into the forehead. This also results in a slight backward pseudoinclination to the forehead. Conversely women had flatter brow bones, no brow bone break and a more vertical and convex forehead shape.
For the male seeking stronger brow bones, the underlying bone usually has to be augmented. Injections methods using synthetic filler and fat can be very effective to create a temporary effect or just some slight augmentation across the brow bone proper. But a permanent and more versatile augmentation approach requires a brow bone implant.
Traditionally augmenting the brow bones requires a coronal scalp incision for access. Once widely exposed the brow bones can be built up with a variety of bone cements or implant materials. Besides the obvious lack of appeal of creating a long scar in the scalp for most men it is difficult to intraoperatively shape bone cements or even adequately place implants at the lower end of the turned down scalp flap.
A more effective brow bone augmentation approach is that of a custom brow bone implant. Using a patient’s 3D CT scan the exact dimensions and brow bone coverage of the implant can be determined BEFORE surgery. This avoids any intraoperative shaping judgments and allows a 3D shaped implant that will fit the bone precisely and create the most symmetric result.
Equally importantly a custom brow bone implant can be place WITHOUT the need for a coronal scalp incision. It can be placed using an endoscopic approach with two small scalp incisions or a single scalp incision combined with two upper eyelid incisions. Which approach is best is determined by the shape and size of the implant. Brow bone implants that some down further along the lateral orbital rims require the eyelid incisions to ensure optimal placement and fixation.
A custom brow bone implant provides a contemporary method of lower forehead augmentation that better meets the aesthetic demands of the male who usually seeks it out. Such implants are apable of being placed without creating adverse scar trade-offs.
Dr. Barry Eppley