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Upper third of the face augmentation is most successfully done in women by the design and fabrication of a custom forehead implant. Given that most women seek forehead augmentation to create an improved convexity and verticality, often with little to no lower brow bone enhancement, it is important to assess preoperative brow position. Some women may benefit from an improved brow position to complement their improved forehead shape.

In the placement of forehead implants, the volume addition may create a bit of a browlift effect as well. This depends on the size of the forehead implant as well as how far down it comes to the brow area. If the subperiosteal dissection and implant placement comes down to the edge of the supraorbital rim, some brow elevation may definitely occur.

When considering a browlift with the concurrent placement of a forehead implant, the two procedures may seem incongruous. While the dissection for implant placement would be identical to that of most brow lifts, the bony coverage by the implant makes any soft tissue brow fixation seemingly impossible.

But this issue can be easily overcome by the thoughtful placement of the screws used for forehead implant fixation. Placing them at the level of the scalp incision provides a convenient point for galeal suture application. Identical to how endoscopic browlift fixation is done the forehead tissues are pushed upward and the suturing between the two is done on both sides over the mid-brow area.

Combining a custom forehead implant with a browlift in females is a complementary upper third of the face reshaping strategy. A browlift is always better supported and maintained if it has more volume to help displace and hold it upward. The key to ensure that it occurs is a good periosteal release across the brow bone from one lateral orbital rim to the other.

Dr. Barry Eppley

Indianapolis, Indiana

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