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Background: The shape of an aesthetically desirous forehead in a female is distinctly different than that of a male. The absence of brow bones is an obvious difference but the overall shape of the forehead is rounder with more vertical inclination. Equally important is the transition into the temporal area which should be seemless as well as having adequate temporal fullness.

The only effective strategy for creating this type of forehead augmentation for females is a custom implant design. The key in making this design is to establish the rounder convexity from the forehead into the temporal region….but without making it too big. In such a design it is important to recognize that implants that cover large surface areas have a lot of volume and a little thickness can go a long way. Thus it is easy to make a female forehead implant too big and over power the face below it.

The other important issue to consider in such female forehead implants is in their surgical placement. While the easiest and obvious approach is to use a full coronal scalp incision for their placement, such a long scar has little appeal to most female patients. The key is being able to place such as implant through a far more limited scalp incision. To successfully do so this has to be aided by endoscopic development of the pocket as well as to check its placement at his inferior and lateral edges.

Case Study: This female desired to have a rounder and fuller forehead. Of particular interest was extending the augmentation into the temporal regions all the way down to the zygomatic arches. With a maximum projection of 4.5mms at its thickest part the entire front of the skull as covered back into the temporal and frontal hairlines .

endoscopic placement technique for custom forehead implant dr barry eppley indianapolisUnder general anesthesia an through a scalp incision between the bony temporal lines endoscopic dissection as done along the orbital rims. This enabled safe periosteal release and protection of the supraorbital neurovascular bundles as well as assured that the dissection into the temporal areas was on the deep temporal fascia all the way down to the zygomatic arches.

Due to the thin temporal wings of the custom forehead implant it is critically important that a complete and full release is done along the perimeter of the implant particularly its anterior and inferior edges. It is very easy to to have the thin edges of the implant fold or be bent if complete pocket dissection is not made. The implant is then inserted through the scalp incision, positioned and secured with two 1.5mm screws.

Prior to scalp closure it is important to check with the endscope all edges of the implant to ensure they are laying flat and not bent or folded. This is particularly relevant at the bottom ends of the temporal extensions.

The custom forehead implant with temporal extensions provides the most definitive method for many female forehead augmentations. Having the implant design go on top of the deep temporal fascia is the key to the rounder forehead shape that extends out onto a non-bony surface. You have to put the implant on top of the muscle to have a smooth transtion and to get the desired convex effect. Never try to put it under the muscle as that is a recipe for a major postop temporal contour issue.

Case Highlights:

1) Augmentation of the female forehead is typically designed to create a rounder shape that is more vertical in inclination and with more fullness out into the temporal areas.

2) A custom forehead implant for a female often incorporates the temporal regions.

3) Placement of the custom forehead-temporal implant is aided by an endscopic technique to avoid the use of a coronal scalp incision.

Dr. Barry Eppley

Indianapolis, Indiana

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