Background: The forehead occupies up to one-third of the face and is largely devoid of many discerning features. Short of the eyebrows/brow bones at its lower end, the characteristics of the forehead are mainly influenced by the aging effects of the overlying skin (wrinkles) and the location of the frontal and temporal hairlines.
The large bony surface of the forehead is generally smooth with varying degrees of convexity. The unique characteristic of the forehead is that its large curved bony surface is exposed to lighting from every angle. As a result every surface feature becomes apparent and even small high and low spots are easily discernible.
Such is the case with the frontal eminences also known as forehead horns. These solitary or paired small bony prominences appear as raised bumps at the upper third of the forehead. Their actual amount of surface elevation is often quite small (a few millimeters) but yet they can be quite visible. Patients particularly mention of their visibility in certain lighting.
Case Study: This male was bothered by a right frontal eminence that was particularly noticeable in various lightings. A CT scan showed a mild increase in bone thickness over the area that was no greater than 2 to 3mms.
Through a zigzag hairline incision located just above it, the small bony prominence was exposed. Its reduction was achieved using a combination of a high speed hanjdpiece and a #8 nasal rasp for final smoothing.
While this is a minor bone reduction perform it through such a small incision mist take into consideration protection of the hair and getting an adequate but smooth bone reduction. Hair protection is achieved by draping off the hair as well as guarding the rotating shaft of the handle. Final bone smoothing is done with the largest pull rasp that exists for the nose. This can be done blindly using the handle of the rasp and with external digital palpation checking for smoothness.
Forehead horns or frontal eminences are small boy protrusions but require meticulous technique to successfully reduce them with no adverse scarring or injury to hair follicles/shafts.
Case Highlights:
1) Frontal eminence (forehead horn) reduction is associated with a modest increase in bone thickness in a circular pattern.
2) These small spot forehead reductions are done by a bone burring technique through a direct overlying hairline or scalp incision.
3) Recurrence of frontal eminence reductions is not a postoperative occurrence I have seen.
Dr. Barry Eppley
Indianapolis, Indiana