Background: The most significant forehead feature in men are the brow bones. While the brow bone shape seems fairly simplistic it actually has a complex topography that is created by the development of the frontal sinuses medially and the frontal skull bone laterally. The perception of the size of the brow bones is determined by a combination of the actual horizontal growth of the brow bones as well as the fullness/projection of the forehead above it.
As the brow bones merge into the forehead above it, a contour dip is created known as the suprabrow bone break. This creates a visible transition between the brow bones and the rest of the forehead and is a distinctly male forehead feature. The bigger the brow bone development the more visible the suprabrow bone break becomes.
When assessing the male who feels their brow bones are too big it is important to look at the suprabrow bone break and the forehead above it. Using computer imaging in the profile view an aesthetic assessment is done looking at both brow bone reduction as well as forehead augmentation without brow bone reduction. It is important to see which type of forehead profile change is most appealing to the patient. Most of the time brow bone reduction is what will look the best. But occasionally it is the forehead development that is at fault which creates a pseudobrow bone hypertrophy appearance.
Case Study: This male was bothered by his brow bone appearance, specifically the area above the brow bones. He felt that the suprabrow bone break, particularly laterally over the tail of the brows, was deficient. He had Radiesse injections to this area which he felt created some minor improvement.
He opted for a custom suprabrow bone implant that built up this area of indentation from one temporal line to the other. This creates a lower forehead augmention that helped decrease the appearance of the brow bones.
Under general anesthesia and through an existing midline deep vertical glabellar furrow, the custom suprabrow bone implant was introduced and placed.
His intraoperative results showed the reduction of the suprabrow bone break, thus reducing his pseudohypertrophic brow bone protrusion.
In male forehead reshaping it is the combination of brow bone and forehead development that creates the overall appearance of the upper third of the face. While most males prefer a distinct separation between the brow bones and the forehead, not all do so. A harsher upper facial appearance may be subdued by softening the brow bone-forehead transition by augmenting the suprabrow bone break.
1) The indication for suprabrow bone augmentation occurs when a pseudo suprabrow deficiency exists (excessive brow bone projection) or when the normal brow bone projection exists and the supra brow bone break is excessively deep.
2) A custom suprabrow bone implant softens or eliminates a deep recess above the brow bone to make a smoother transition from the brow bones up into the forehead.
3) A custom suprabrow bone implant can be inserted either through an anterior scalp incision or through a deep glabellar furrow if it exists.
Dr. Barry Eppley