Brow bone augmentation is often desired and requested by men for a more masculine appearance. While injectable fillers and fat can provide some temporary augmentative effects, a sustained and stronger brow bone effect requires placement of a non-resorbable material. While an implant would be such a permanent method, there is no preformed brow bone implants that are available. In addition, even if standard brow bone implants did exist, the approach of placing it through an open incision and the extensive scalp scar that would be created would make it a suspect aesthetic choice for most men.
The use of a custom brow bone implant is an ideal permanent brow bone augmentation method. Using a silicone biomaterial, the implant is fashioned from the patient’s 3D CT scan. The desired implant shape and dimensions are created beforehand with emphasis on the location of the brow bone prominence, its thickness across the length of the brow bones and the location of the supraorbital nerve locations.
Because it has a performed shape and the silicone implant has some flexibility, its placement can be done with an extensive scalp incision. To the contrary it can be placed using an endoscopic technique through small 2.5 cm incisions either at or behind the hairline. Such incisions typically heal with imperceptible scars. The endoscope allows the subperiosteal pocket to be developed and released along the brow ridge area with observation and preservation of the supraorbital neurovascular bundles.
Once the pocket is made the brow bone implant can be easily slide through one of the small incisions into place. Because it is a custom made implant its accurate placement is aided by its precision shape. Once in place the decision can be made about whether to secure it with a small titanium screw or not. I prefer to do so and it with an endoscopic method after passing the screwdriver down to the implant through a small central 3mm horizontal low forehead incision. The screws is passed with an instrument into position over the implant and the endoscope guides the screwdriver into place to drive it through the implant and into the underlying bone.
The custom brow bone implant offers a relatively simple and permanent method for brow bone augmentation. It is easily placed and secured through an endoscopic technique which causes minimal scarring to do so.
Dr. Barry Eppley
Indianapolis, Indiana