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Background: There are distinct well known shape differences between the female and male forehead. While it is a broad near featureless facial area it still has gender specific characteristics. Compared to the male forehead the female forehead has a more vertical slope to it (partially because it lacks any significant brow bone prominences) and has less prominent bony temporal lines. (giving it a more round softer appearance) 

When designing a custom forehead implant for females the one feature that is most easily created is the slope. Established in the profile view the slope of the forehead is determined by the angle from a vertical line drawn up from the brow bones. A truly vertical forehead (zero slope) is rare and is not usually the most aesthetic. Female forehead verticality infers that that is some slope even if it is slight. (around 10 degrees) It is important to know where the frontal hairline is on the frontal bone as that plays a key role in establishing the slope as well as the maximal thickness of the implant in the upper half of the forehead. The slope angulation is ultimately determined by the line drawn between the brow bones and the edge of the frontal hairline.

Once the slope is set then the shape of the forehead implant from side to side can be established. In females this is usually going to have a rounder shape with the temporal lines set back from the central maximal area of projection. Whether the implant design needs to extend past the bony temporal lines onto the temporal muscle fascia depends partially on the amount of forehead projection created and whether any natural temporal hollowing is present.

Case Study: This female had long wanted a more vertically inclined forehead. She wore bangs to hide the shape of her forehead and had done so her entire life. As a result a custom forehead implant was designed that had a near zero slope to it which required 9mms of upper forehead projection. She had a brow bone to frontal hairline distance of 6cms.  

Under general anesthesia and through a small irregular scalp incision placed behind her long standing bang part line the soft tissues over the forehead were elevated. It was also necessary to elevate the scalp’s soft tissues behind the incision as well.

The forehead implant was prepared by making midline markings on its posterior part using 3mm dermal punches.

The implant was rolled, inserted and then unrolled once inside. The implant was moved around, using its midline markings to help guide it, until it found a good position (north-south) where not edging of the implant near the brow bones and the temporal lines could be seen or felt. It was then secured into that position by two self-drilling microscrews. The scalp incision was then closed over a drain.

Her intraop result shows the attainment of a new vertical forehead slope in profile. Despite the change in slope the forehead did not look too narrow in the frontal view.

As the slope of the forehead is decreased by increasing the projection of the upper forehead there are concerns as to how it affects the shape of the forehead in non-profile views. Thus an important part of the implant design is how it blends onto the sides in a natural way without an acute angle.

If done properly, and easier to do in a female than a male, the upper forehead slope change should not make the forehead look too narrow or increase the appearance of temporal hollowing.

Case Highlights:

1) Forehead augmentation in most females focuses on improving the vertical slope on profile and keeping more of a rounded shape.

2) Creating a completely vertical forehead requires the greatest thickness of the custom forehead implant to be at the upper 2/3 of the forehead. 

3)  A non-brow bone forehead implant can be placed through a relatively small scalp incision compared to the size of the implant.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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