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Brow bone enhancement is often done as part of an overall forehead augmentation procedure/implant for both men and women. When only brow bone augmentation is requested, however, this is usually an exclusive male aesthetic procedure. Because of the need to limit the extent of any scalp incisions to the smallest extent, a premade custom brow bone implant is made and inserted in an endoscopic-assisted technique.

In the preoperative design of a custom brow bone implant, there are variety of shape and dimensional features to it that create the final aesthetic outcome. Simply designing it as an homogenous augmentation from one lateral optical rim to the other will not create the most natural and aesthetic brow bone shape. How much increased brow bone projection and how that blends into the lateral brow area down along the orbital rim are some important design features.

But one subtle but important brow bone feature is often overlooked and that is in shape in the central glabellar region. In looking at male brow bone shapes on skull models, which are formed by the protrusion of the underlying frontal sinuses, it is clear there is a central depression. The brow is not a straight line protrusion from side to side. Due to the central septum of the frontal sinus there is usually no protrusion centrally. This creates a v-shape to the glabellar region of the brows.

Thus it it important in a custom brow bone implant that this glabellar shape be incorporated into its design. If it is not done so, or is not accentuated enough to be seen intraoperatively, it can be done by hand prior to final implant placement.

The one aesthetic merit to an inward depression along the brow bone is that it takes the maximal brow bone projection over the iris-pupil complex of the eye look more pronounced.

Dr. Barry Eppley

Indianapolis, Indiana

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