Background: There are well known gender differences in the shape of the forehead. The primary characteristics of the male forehead is a well defined brow ridge, a wider and slightly backward sloped shape, low set eyebrows and various forehead lengths based on the natural location of the frontal hairline. While some men only need non-brow forehead augmentation (subtotal) others desire total combined forehead-brow bone augmentation which requires a more complex implant design and placement technique.
In designing a forehead-brow bone implant the projection of the brow bone and forehead above it is usually not equal in many cases. Some brow bone deficiencies are associated with an increased backward slope to the forehead. Thus as the brow bone comes forward the upper forehead needs to be even more so. With this projection the width of the forehead also needs to be established with a more flat profile (non-round shape) But in making the forehead wider it is also important to not try and make it too prominent at the bony temporal line at the sides of the forehead. This is often associated with making the forehead more square but risks making an unnatural ridge along the side of the forehead that sticks out from the temporal region next to it.
Placement of the male custom forehead-brow bone implant is typically done in a retrohairline location. How far one goes behind the hairline is a matter of preference but to get good dissection and release along the brow bones the incision can not be too far behind the upper curve of the forehead. Another option is to place an incision right at the hairline. This requires good hairline density but also another reason to do so such as a concomitant frontal hairline advancement. This poses its own unique set of challenges.
Case Study: This male desired a total forehead augmentation to help masculinize his upper face which was a bit too round/soft. At the same time he also desired a modest frontal hairline advancement. A custom forehead implant was designed hat provided 5mm brow projection, 6mms upper forehead projection and a flatter/wider overall shape.
By looking at implant thicknesses it can be seen that the greatest projection was at the brow bones and at the upper curve of the forehead.
He desired a small amount of frontal hairline advancement which had to are kept limited due to the expansion effect on the overlying tissues of the implant placement.
When seen four years later the long term effects of the forehead augmentation could be fully seen.
The frontal hairline incision is a convenient method to place a forehead implant due to the direct access particularly when the brow bone tissues must be elevated. Combining it with a frontal hairline advancement is a bit contrarian in that augmentation of the forehead lifts the forehead skin a bit and lessens the amount that the hairline can be advanced. Some frontal hairline advancement is still possible but don’t expect it to be as great as would be accomplished with0ut the forehead augmentation.
Key Points:
1) Masculinizing the male forehead through brow augmentation and slope correction can be effectively treated by a custom forehead implant design.
2) The male custom forehead implant can be placed through a frontal hairline incision if good hair density exists and only a limited frontal hairline advancement is needed.
3) In male total forehead augmentation the increase in upper forehead projection usually needs to be greater than the brow bone projection
Dr. Barry Eppley
World-Renowned Plastic Surgeon