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Background: In aesthetic forehead augmentation what differs between male and females is the brow bone component. Females usually do not have a brow bone section of their implant or, if it does, it does not extend beyond the forehead projection above it. While men can have a forehead implant alone, if they have good brow bone development, very often the brow bone and forehead together lack adequate projection so a combined augmentation is done.

While there are some off-the-shelf forehead implants available they are not usually for men. They provide more of a rounded and central forehead augmentation effect which, while effective for some women, is not what most men are seeking. They do not have a brow bone component, and even if they did, would not work for most men as the shape and projection of the brow bones is for more unique than that of the forehead above it.

As a result a custom forehead-brow bone implant is what is needed for male upper facial augmentation. In designing such an implant the first realization is that, while the forehead is typically perceived as the visible structure that exists between the upper eyes and the frontal hairline and stops on the sides short of the temples, those are not usually the limits of an implant design to augment it. The forehead or an anterior surface of the skull is one of its five surfaces. Like all other skull augmentations it is rare that an implant design covers only one surface unless the augmentation is very small. The bigger or more projection the implant has the more it must spread out and extend onto the surrounding skull surfaces to look natural. 

Case Study: This male has a prior history of a forehead augmentation procedure with a non-brow bone forehead implant made of silicone which was very thin. It was placed through a small scalp incision behind the frontal hairline. Its aesthetic impact was limited.

In considering a secondary forehead augmentation that included the brow bones and was to have a more substantial effect a new custom forehead brow bone implant was designed. It provided 10mms of upper forehead augmentation and 8mms of brow bone augmentati9n with a total volume of 130ccs. With this amount of forehead augmentation the top and sides of the implant design needed to extend way back onto the top of the head as well as into the upper temporal regions crossing over the bony temporal lines.

Under general anesthesia and through his existing scalp scar his small indwelling forehead implant was removed. When compared to the new implant replacement the size and shape differences was considerable. The removed implant measured 2.5mm at its greatest thickness and had a volume of 11ccs.

The existing implant pocket was widely expanded and the new custom forehead-brow bone implant placed through the same scalp incision. It is hard to believe to imagine that the new much larger implant could be placed through the same incision as the much smaller one.

Once the new implant was positioned low enough over the brow bones it was secured in the midline with two microscrews. The scalp incision was then closed in multiple layers with resorbable sutures over a drain.

His intraoperative side profile demonstrated the dramatic improvement in the forehead augmentation effective with the custom implant design.

Case Highlights:

1) There are no standard forehead implants anywhere in the world which provides concurrent brow bone augmentation as well. Only a custom implant design can do so. 

2) In significant forehead-brow bone implant augmentation the implant must extend further back onto the skull and onto the sides of the head to not look unnatural. 

3) A custom forehead-brow bone implant requires a scalp incision for placement as well as significant subperiosteal release across the brow bone for accurate placement.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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