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Background: Augmentation of the forehead can be done like any other facial bone. (technically the forehead is actually part of the skull) What is unique about forehead augmentation, particularly in the male patient, is the consideration of the brow bones which have a different shape and thickness. This consideration is also relevant for women but is different because women do not ask for brow bone augmentation by itself. (at least not in my experience to date)

Men seek brow bone augmentation not only for a more masculine appearance but also to improve the appearance of the eyes. Lack of brow bone projection can create an open eye or over exposed eye look due to a deficient overhanging brow bone. When considering brow bone augmentation better coverage of the eye can not considered without its effect on the forehead that lies above it. The question is whether the forehead should be included or not as part of the brow bone augmentation.

There are numerous considerations about how the brow bone should flow up into the forehead. Prominence and location of the brow bone break, vertical slope of the forehead and how the brow bone blends into the lateral bony temporal lines are some of the most important.

Case Study: This male had a prior history of a custom brow bone and infraorbital rim implants to provide improved bony eye coverage. A major emphasis on the brow bone implants was the need for significant lateral brow bone coverage. After three months of healing and swelling resolution he determined that there was too much lateral brow bone prominence as it blended up into the lateral temporal line.

As a result a new custom brow bone implant was designed that incorporated the entire forehead to create a smoother transition from brow bone to forehead with upper outer brow bone implant prominence. (original brow bone implant in green, new forehead implant in teal color)

Exchange of the existing brow bone implant for the new custom forehead brow bone implant was done through his existing three incisional approach. (hairline and lateral upper eyelid)

It is difficult to always accurately predict the effect on an implant on the overall forehead shape. What make look good on a design may not always look good or how the patient perceives it to be after it is placed. It is easy to see after the fact that a significant lateral brow augmentation can throw off the balance of the lateral brow bone transition into the sides of the forehead because of a newly created temporal line ‘deficiency’.

Case Highlights:

1) Brow bone augmentation can be done either by itself or in combination with a total custom forehead implant.

2) The decision for a total forehead or isolated brow bone augmentation depends  on how much brow bone augmentation is being contemplated and the natural shape of the forehead above it.

3) The prominence and shape of the lateral temporal line is an important aesthetic consideration in either small brow bone as well as larger forehead brow bone implant designs.

Dr. Barry Eppley

Indianapolis, Indiana

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