Male Custom Forehead Implant Case Study

Introduction

Forehead implants are a surgical option to permanently reshape or augment the forehead, typically used to improve projection for flat or recessed foreheads. The concept of forehead implants may be partial or complete based on whether a brow bone augmentation effect is desired or not (forehead vs forehead-brow bone implant ) For purposes of this case study it focuses on non-brow bone forehead augmentation.

The vast majority  forehead implants are custom made from the patient’s 3D CT scan.  A limited number of off-the-shelf forehead implants are available for modest forehead contour changes. But the uniqueness of each patient’s forehead anatomy and their aesthetic goals make custom implant designs with the likelihood of an aesthetic outcome that comes the closest to the desired outcome  While different implant materials exist solid silicone is preferred as it can be placed through the smallest possible scalp incision and the easiest to revise.

Two important considerations for all forehead implants are: gender specific designs and how do they compare to less invasive  injection techniques.

While there are numerous shape differences in masculinizing vs feminizing the forehead a basic one is in the profile (side view) The male forehead often slopes slightly backward from the brow while the female forehead gently projects forward above the browThis profile distinction is critical in implant design for male vs female patients.

Both implants and fat grafting are used to improve forehead shape, but they work in very different ways. The best choice depends on how much change is needed, how permanent it needs to be, and how specific and significant the augmentation effect needs to be. Each method has their advantages and disadvantages.

Forehead Implants

Advantages

• Create structural projection and contour
• Correct flat, recessed, or irregular bony foreheads
• Provide precise and permanent shape change
• Excellent for major contour changes
• Does not depend on tissue survival

Limitations

• Requires scalp incision
• Open  invasive surgery
• Higher upfront cost
• Risk of implant infection

Fat Grafting to the Forehead

Advantages

• Softens contour transitions
• Adds subtle fullness
• Improves skin quality due to stem cells
• Uses your own tissue
• No implant or foreign material
• Less invasive than implants

Limitations

• Unpredictable volume retention
• Often requires multiple sessions
• Cannot correct true bony deficiencies
• Results are not fully permanent

Side-by-Side Comparison

Case Study

This male desired correction of his sloped forehead. He was not unhappy with its shape, just the slope to it. The backward slope measured 69 degrees (technically this is a curved slope but will use a straight line as an approximation). His goal was a modest augmentation but keep the same forehead shape.

A forehead implant was designed with 6mm of projection at the mid point of the arc. The added projection and kept the same forehead shape with its greatest effect centrally. This changed the forehead slope to a more vertical inclination of 83 degrees. The total implant volume was 24ccs.

Under general anesthesia the implant was placed through a 3.5cm scalp incision with double microscrew fixation.

His forehead profile improvement was significant and likely more than one would expect from a 6mm thickness.

Discussion

In male forehead  augmentation the key change is a straighter or slightly backward-sloping forehead with limited central forehead convexity. As opposed to the objective in females of a straighter and more convex forehead shape.

Profile Differences (Side View)

• Male: Forehead often slopes slightly backward from the brow
• Female: Forehead gently projects forward above the brow

Forehead Augmentation by Sex

This profile distinction is critical in implant design and volume creation. The one significant advantage of a custom implant, as opposed to fat grafting, in creating these different forehead shapes is the precise preoperative control of the shape of the augmentation through varying material thicknesses.

In doing these designs for the forehead  there are several learned insights. First, because of the relatively limited thickness of the forehead soft tissues there is a near 1:1 ratio of the implant’s shape and thickness from the design to the visible aesthetic effect. Second, the large surface area of the forehead and the implant’s volume has a stronger shape change than any linear thickness number would be expected to create. Third  due to its large exposed surface on the non-hair bearing face any aesthetic change will be very visible to the patient.

Forehead augmentation is not gender-neutral surgery. The difference between a patient satisfying result and an undesired or unnatural one often comes down to a few millimeters of the implant design.

Key Points

1. The male custom forehead implant is primarily a profileplasty procedure  to change the forehead slope.
2. Most custom forehead implants can be placed through relatively small scalp incisions.
3. The custom implant design process  is not an exact science and due to the large surface area of the forehead over correction is more of an aesthetic concern than undercorrection.

Barry Eppley, MD, DMD

World-Renowned Plastic Surgeon