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Background: The shape of the forehead in a male is dominated by one structure, the brow bones. That is the distinguishing feature that separates the male vs female forehead shape and is directly the result of an increased pneumatization of the frontal sinuses. The protruding convex brow bones separate from the forehead above it through a concavity known as the suprabrow bone break. The larger the brow bones become the deeper the central suprabrow bone break is seen.

The traditional approach for the male with excessive brow bone protrusion is an open brow bone reduction procedure using a bone flap setback technique. While effective the need for a moderately long scalp incision to do so can be prohibitive. An alternative strategy is a camouflage one where the depth of the suprabrow bone break is lessened. Computer imaging can be done to show the effects of suprabrow bone augmentation vs brow bone reduction to determine whether that is seen as a beneficial aesthetic improvement.

Augmenting the suprabrow bone area can be done by a variety of techniques which are fundamentally divided into either bone or soft tissue augmentation. For those seeking a permanent bone augmentation method the use of bone cements or implants can be done. For the smallest possible incisional access for the augmentation a custom suprabrow bone implant is the best solution.   

Case Study: This male patient was bothered, not so much by his prominent brow bones, but by the deep central suprabrow bone break or hollow above them. Rather than have an open brow bone reduction he preferred softening of the brow bone prominence by filling in the central deep area above them.

To accomplish this augmentation a small 3.5mm thick suprabrow bone implant was designed to fill in this central forehead depression.

Under general anesthesia a 3.5cm long scalp incision was made just behind the frontal hairline. Using an endoscope a subperiosteal pocket was developed down to the central brow bones and into the glabellar furrow. Prior to insertion the implant had several 3mm perfusion holes placed through it to allow for postoperative tissue ingrowth since no screw fixation was used.

With the implant in place the small incision was closed which will go on to heal in an imperceptible fashion.

The immediate result shows a more gradual slope back up into the forehead. This filled in the central lower forehead depression and allowed for a less inclined forehead in profile.

Prominent brow bones in men can be exacerbated in appearance if the forehead above it has a backward slope to it. This creates a deep depression above the brow bones which magnifies their amount of forward protrusion. While the definite treatment for prominent brow bones is a brow bone reduction procedure, such an approach may be more than some men are willing to do. The alternative is to camouflage the brow bone protrusion by augmenting the forehead above it. This is best done by a custom design implant where the amount of forehead coverage can be tailored exactly to what suits the patient’s aesthetic needs. That can be just a central suprabrow bone break augmentation as in this case or an overall above the brow bone forehead augmentation. Such implants can be placed through a far more discreet scalp incision with a much more rapid recovery. 

Case Highlights:

1) Strong brow bones in a male are typically treated by brow bone reduction techniques that set back the projection of the bone.

2) A brow bone prominence can be camouflaged by a suprabrow bone break augmentation. (low forehead augmentation)

3) A deep central suprabrow bone break can be treated by a custom forehead implant design inserted through a very small scalp incision.

Dr. Barry Eppley

Indianapolis, Indiana

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