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Brow bone reduction is a procedure that is done in both men and women to reshape their forehead. Men undergo the procedure to reduce a very prominent brow bone protrusion to eliminate a ‘Neanderthal’ appearance. Transgender male to females have the procedure to feminize the forehead and eliminate any semblance of a brow bone break. In both types of patients the only effective brow bone reduction technique is an osteoplastic bone flap setback as the amount of reduction exceeds the thickness of the anterior table of the frontal sinus.

Females undergo brow bone reduction much less frequently (probably 10:1 men to women who have the procedure) as it would be unusual for them to have a significant brow bone protrusion. These smaller protrusions do not usually require a bone flap setback technique as the amount of reduction needed can be done by bone burring alone. If the reduction needed is less than 4mm between the pupils (vertical line draw up superiorly) where the frontal sinus lies, bone burring can create an effective reduction. A preoperative x-ray can clearly show how thick the anterior sinus table is which will allow one to determine how much bone can be removed before entering the frontal sinus. Females also have the advantage of not only is the anterior frontal sinus expansion less than in males, the lateral extent of the paired frontal sinuses are also less. This means there is more solid bone on which to work.

Burring reduction (also known as shaving) of the brow bones also has a role in secondary or revisional brow bone reduction surgery. To gain a few extra millimeters or to smooth out irregularities and asymmetries, high speed burring offers an effective reshaping technique. This can apply to either a prior osteoblastic bone flap setback or a primary burring procedure in the properly selected patient.

Burring brow bone reduction can be done in some cases through less of an incisional scalp access than the osteoblastic bone flap method. But the concept of attempting doing it through an endoscopic approach, while appealing, is not an effective method.

Dr. Barry Eppley

Indianapolis, Indiana

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