Background: There are well known gender differences in the shape of the forehead. The primary characteristics of the female forehead is the lack of a well defined brow ridge, a more vertical and rounder shape, higher positioned eyebrows and usually a shorter forehead length. As a result of these norms an excessively backward forehead slope in a female is not aesthetically desired. How much backward slope can be tolerated is up to each individual’s aesthetic preference. But from a numbers standpoint when the slope of the forehead is greater than 10 to 15 degrees or more it will be seen as a significant aesthetic forehead deformity.
The definitive correction of a backward sloping forehead is a custom implant. While called a forehead implant in the backward sloping forehead the correction must go beyond the front of the skull. (which is typically perceived as the forehead) While in a normal shaped forehead there is a more obvious transition between the forehead and the top of the head. But in a backward sloped forehead the two run together. As a result a forehead implant design must extend way back onto the top of the head often right back to the front edge of the crown. The more the slope is corrected the further back the implant must extend.
When significant forehead slope correction (augmentation) is done there will also be considerations as to how it blends into the side of the forehead/temporal area as well as its effects on the frontal hairline.
One should expect that any temrpotal hollowing that exists will become greater as most forehead implants stop at the bony temporal line at the side of the forehead. Also larger amounts of forehead augmentation will lengthen the forehead a bit through some modest elevation the frontal hairline.
Case Study: This female desired forehead augmentation with the main reason being to decrease the backward slope of her forehead. (which depending upon how you choose to measure it was greater than 15 degrees)
A custom forehead implant was designed that added 12mms of projection at the steepest part of the slope. To make for a smooth transition onto the top of head the design extended all the way back to the crown of the skull. This created an implant volume of 106ccs.
As a female with a thick head of curtly hair the initial surgical challenge was to find a way through the hair to make an incision. From this very posterior incision placement a subperiosteal pocket was developed all the way down to the brow bones and along the bony temporal line.
Prior to surgery she felt the forehead projection was a bit too much so if it looked too strong/big she asked me to do reduce it. After its initial placement it looked a bit much so I shaved it down using a scalpel technique on a small fixed table.
The implant inserted, positioned and secured with two microscrews at its back edge through the incision.
The reduction in the forehead slope was immediately apparent.
Forehead augmentation for optimal correction is not as simple as it seems unless the need is only a few millimeters of augmentation of the central forehead. Forehead uaugmentation, particularly when a significant backward slope exists. It is better thought of as a form of skull augmentation which comes with the consideration of how it blends into the adjoining bone on top of the head and temporal muscle on the side of the head. (aka make it look normal) Its surface area coverage needs to be greater than what one may think and this becomes more so the greater the slope correction becomes.
Key Points:
1) The sloped female forehead can be effectively treated by a custom forehead implant design.
2) The greater the backward slope of the forehead is the more it needs to extend back along the top of the skull.
3) With significant forehead slope correction line of its expected augmentation effects is that the forehead length will get a bit longer.
Dr. Barry Eppley
World-Renowned Plastic Surgeon