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Aesthetic brow bone augmentation and even brow bone contour reconstruction is almost always best done with a custom implant approach. Using the patient’s 3D CT scan the precise shape and projection of the brow bones can be preoperatively designed. This is a far superior approach to creating the complex topographic anatomy of the brow bones over intraoperatively trying to do the same with bone cements or various standard implant materials.

But even in custom brow bone implants, patients may decide later that they wish changes in the design after they have ‘worn it for awhile’. While considerable thought is put into the implant’s design no one can predict with absolute accuracy whether it will achieve the patient’s desired look or if they may decide for a change in its shape after surgery even with an uncomplicated and apparent satisfactory aesthetic outcome.

The obvious solution to a desire to change a custom brow bone implant design after implantation and healing is to simply design a new implant. The aesthetic outcome of the existing design is enormously helpful in knowing what changes to make that would be more aesthetically desired. But the cost of a new custom implant design may be a limiting factor for implant replacement surgery.

An alternative approach is to intraoperatively modify the existing custom brow bone implant. This is straightforward when it comes to reduction of desired areas of the implant but it is more challenging when additions are needed. A technique I have found useful for such additions is the application of ePTFE sheeting. Such sheets come in various thicknesses and are easily cut into any shape. They are applied to the existing implant with sutures. This is an example of a patient desiring more inferolateral projection across the lower edge of a custom brow bone implant.

ePTFE sheeting is quite customizable and adaptable to any implant’s shape. The material has a well established clinical history of tissue ingrowth/adherence, making it only necessary to secure it to the implant with sutures for immediate placement security.

Dr. Barry Eppley

Indianapolis, Indiana

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