Background: One of the anatomic features of the forehead, most prominently seen in men, is the supra brow bone break. This is the transition between the prominence of the brow bones and the beginning of the more vertical forehead slope. The more prominent the brow bones the deeper the brow bone break is which is why it is seen in most men but not women. The most visible part of the break is in the center at the glabellar valley between the paired medial brow bones where it is the deepest.
In softening or eliminating the supra brow break there are three options; synthetic injectable fillers, fat injections and bone-based implants. Each has their merits and how significant/deep the supra brow bone indentation is will influence the choice of these three approaches. Also influencing this decision is the level of aesthetic concern one has and how much effort one wants to put into correcting it.
As a general guideline injectable fillers are used when the patient wants to try the change and see if the like it. As an office procedure it is completely reversible and it best used as a ‘test’. Custom implants are for deep supra brow bone breaks and the patient seeks a maximal and permanent result. Fat injections are done instead of fillers when one is already having surgery for other aesthetic procedures. This is the time to try fat injections as the harvest and injections are painless since the procedure is already done under anesthesia. The unpredictability of fat injection survival is always present but the opportunity factor is there to try an autologous approach.
Case Study: This male was having other facial procedures done and asked about treating his supra brow bone break which was of moderate depth. Fat injections was chosen as the treatment method as he was having fat removal in other areas as well.
Using a cannula injection technique fat harvested from the buccal fat pad was processed into a more liquid form by passing back and forth between 10c syringes 20 times. Then using a small injection cannula 3.5ccs of fat was injected into the supra brow bone break from two different injection direction.
His intraop results showed the near complete elimination of the supra brow bone break.
Ni matter where you put fat injections their advantages and disadvantages are the same. It is an autologous procedure that has the disadvantage of unpredictable volume retention. How much volume is maintained will be maintained by 6 weeks after the procedure. But for a modest concern about the depth of the brow break and if one is undergoing another procedure any way, particularly buccal lipectomies, this would be the opportune time to give fat injections a try.
1) The suprabrow break is the transition between the brow bones and the forehead whose depth is variable based on gender and anatomic development.
2) Softening the brow bone break can be done either by fat injections or an implant based on its depth and the patient’s motivation to soften or eliminate it.
3) The logic of choosing fat injections for treating the suprabrow bone break is for a minimal and economic approach not because it is an assured long term outcome.
Dr. Barry Eppley
World-Renowned Plastic Surgeon