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There are a variety of small contour irregularities (lumps and bumps) that can occur on the forehead from either congenital or traumatic origins. Such bony prominences, even if they are small in. size can be very visible on the broad expanse of the forehead. The reflection of the light from various angles on the forehead can make even the small irregularity visible and aesthetically concerning.

While such forehead irregularities can easily be burred down by a high speed handpiece, as is done anywhere else on the skull, getting adequate incisional access to do so may create its own aesthetic liability. In the spirit of the important aesthetic concept of ‘a small problem deserves no more than a small procedure’ taking down small forehead raised bony areas should be done with the smallest incision possible.

A skull reduction technique that only needs a very small incision is the use of large bone rasps. While originally made for nasal bone reduction their large teeth a re very aggressive about removing bone. Because it is a manual method for making the rasp work the incision can be very small. Like the high-speed hand-piece it does require a direct  or near direct line of access as the rasps are either straight to have only a 15 to 209 degree angle. The straighter the rasp is the better as it takes force on the pullback to get the teeth of the rasp to bite into the bone and remove it. After numerous back and forth motions the rasp can take off a surprising amount of bone. The small incision is closed with dissolvable sutures.

When the frontal hairline does not permit good incisional access the temporal hairline can be used. With the small incision needed for rasping the healed scar will be invisible.

Dr. Barry Eppley

World-Renowned Plastic Surgeon


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