In the lower two-thirds of the face there are numerous standard implants for aesthetic augmentation. In the upper third of the face, however, no such options exist. This undoubtably is because of the low number of patient requests historically for aesthetic forehead and brow bone augmentation. It also speaks to the anatomic reality that the shape of the forehead and brow bones is very unique amongst each person and such larger surface area standard implant shapes may not work well in this facial area for many patients.
As a result brow bone augmentation in particular is currently done using custom implant designs built on the patient’s 3D CT scan. Having done numerous custom brow bone implants there are certain features of their design that has been learned about their shape and how to vary their thicknesses from side to side. To put that knowledge to the test I recently had a patient who one day before his sheduled facial csurgery decided to have add on brow bone augmentation…with no custom implant preparation in advance. We both agreed that I would use and modify an existing implant to do so.
Using a sample skull implant I hand carved down a brow bone implant into a shape hat I fed would create the desired effect. The key is to use an implant base that has adequate wide from side to side. If it doesn’t adequately reach the frontozygomatic suture line on each side it is not going to really fit. As long as that is achieved the shape between the two implant ends can be satisfactorily made.
It is always best to custom make just about any facial implant from the patient’s 3D scan for the obvious reasons. But under less than ideal conditions a brow bone implant can be handmade IF one happens to have a standard skull implant available.
Dr. Barry Eppley