Background: One distinct male feature is the of a prominent brow bone at the lower end of the forehead. It is one of many facial features that distinguishes males from females. It extends over the eyes with a horizontal projection, has a brow bone break before heading up into the forehead and has a slight depression between medial brow bone prominences.
In today’s male beauty trends many models display a very strong or exaggerated brow bone appearance. It borders on being an almost angry appearance but is better anatomically described as an ultra low brow bone projection with near complete coverage of the upper eyelids. While I frequently get requests for such a brow bone augmentative change, I have to advise such requests that is almost always not possible. This is due to the fact the soft tissues of the eyebrows is very tight and can not be driven down below the existing brow bones unless these tissues have been first expanded before a brow bone implant is placed.
More realistic brow bone augmentation results create less dramatic changes but appreciable improvements nonetheless. More horizontally oriented projection across the orbital rims, a brow bone break and a more distinct corner or tail of the brow bone are achievable augmentative changes.
Case Study: This young male desired a brow bone augmentation implant which was designed off of his 3D CT scan. Despite its small size, brow bone implants have a complex design to get the various topographic changes from side to side and top to bottom. It is not just a simple solid roll of implant material across the brow bones.
Under general anesthesia an initial 2 cm incision was made in the midline behind the frontal hairline. Endoscopic subperiosteal dissection was done over the entire forehead and across the brow bones. The periorbita was released from side to side and the supraorbital nerves identified and released from the bone. The lateral orbital rim dissection was completed by making small upper eyelid incisions in a lateral skin crease. This ensures that the sided ‘tails’ of the implant are properly positioned down to the frontozygomatic suture and the entire implant is positioned low enough over the supraorbital rims. Small screw fixation is used to secure the implants on the lateral orbital rim.
Custom brow bone implants usually require a three incision placement technique, all of which are small and heal inconspicuously. The key is to get the implant low enough over the brow bones through adequate soft tissue release and good positioning and fixation over the lateral orbital rims.
1) Isolated brow bone augmentation is typically requested by men with indistinct supraorbital ridges.
2) A custom brow bone implant allows for the least amount of incisions for placement.
3) A three incision approach is used for custom brow bone implant placement including a small scalp and bilateral lateral eyelid incisions.
Dr. Barry Eppley