Aesthetic forehead augmentation to correct a sloped, irregular or deficient frontal bone can be done by a variety of materials placed on top of the bone. Having used every one of them, they each have their merits and each material type can be successfully used in experienced hands. But the forehead augmentation method that has the best results is that of a custom forehead implant.
Besides being able to create the exact shape and thickness desired before surgery, a preformed custom forehead implant can also be inserted through the smallest scalp incision. While the use of bone cements require a full coronal incision to be placed in most cases, a custom forehead implant can be inserted through an incision that is limited to between the bony temporal lines. This avoids extending the incision onto the temporal area on the sides of the head where the scar can be more easily detected and always gets wider than that across the top of the head.
The biggest concern about placing a custom forehead implant is to get it low enough over the brow bones if that is the way it was designed. Placing a forehead implant that does not involve the brow bones is far easier and adequate positioning is almost never an issue. But placing a complete custom forehead implant that must go over the brow bones first requires a subperiosteal release and supraorbital nerve dissection. This must be done with an endoscope given the limited size of the scalp incision. Once the forehead implant is inserted checking its placement with an endoscope can also be done.
The use of the endoscopic technique in a custom forehead implant is to ensure as best as possible the extent of the subperiosteal pocket and protection of the supraorbital nerves. It is not used because it can limit the extent of the scalp incision like is done is more traditional endoscopic browlift surgery.
Dr. Barry Eppley
Indianapolis, Indiana