Background: Of all facial areas for aesthetic structural augmentation the brow bone is the most unique. It may be a relatively small area but its shape is complex and is very visible sitting right above the eyes. It is also a very gender specific facial feature in which requests to do so are almost always in men. Most men that request brow bone augmentation have visibly flat brow areas and aesthetic requests vary from a mild amount of change to very strong brow bone appearances.
Like any form of facial augmentation there are various methods to do so. Injectible fillers are useful to test the concept. Injectabpoe fat has a role when the patient seeks a non-implant method. Implants, however, are the definitive method for brow bone augmentation since they are permanent and provide a strong push on the tight lower forehead tissues. When it comes to brow bone implants there are no standard brow bone implants. Various materials (e.g., ePTFE sheeting) could be fashioned to make some type of a brow bone implant but this is far from ideal.
The best method to make a brow bone implant is the custom approach using the patient’s 3D CT scan. This allows for creating a specific implant footprint, shape and various thickness across the lower forehead that is felt to come closest to achieving the patient’s aesthetic goals.
Case Study: This male desired to have increased brow bone projection. Using his 3D CT scan a custom brow bone implant was designed with 6mms of projection at the medial mound brow area and 4.5mms at the lateral mound brow areas.
Under general anesthesia and initially through a 3 cm frontal hairline incision the subperiosteal pocket location was created. Initially the dissection was carried over onto the lateral orbital rim area using endoscopic visualization.
The brow bone implant was inserted and positioned and endoscopic visualization showed that it was laying flat into the lateral orbital rim areas.
To be certain of optimal placement (low enough on the brow bones) small upper eyelid incisions were made in the outer skin creases too check where the tail of the implant was sitting as well as secure it with a small microscrew per side.
His intraoperative side profile showed the brow bone augmentation change. (with some swelling)
The custom brow bone implant is the superior surgical method for this form of lower forehead augmentation. To be a truly effective aesthetic procedure its placement must be able to be done with minimal/invisible scarring. Only a preformed implant can achieve that effect. A good implant design is also needed as the brow bone is not a straight horizontal bar of bone. It has a fairly complex shape and its projection from one lateral orbital rim to the other is not uniform.
1) The only reliable method of brow bone augmentation is with a custom brow bone implant.
2) The placement of a custom bone implant is done through a small scalp incision aided by endoscopic visualization…and possibly small upper eyelid incisions.
3) The design of a custom brow bone implant is more complex than it seems with numerous shape and thickness considerations.
Dr. Barry Eppley
World-Renowned Plastic Surgeon