The typical perception of brow bone reduction is a horizontal decrease in the projection of the supaorbital rims. Such surgery is done for either the male who has large ‘Neanderthal-like’ brow bones or in facial feminization surgery for either transgender or non-transgender patients. While such facial bony reductions can be done by burring alone, more significant reductions require removal of the entire anterior wall of the frontal sinus which is reshaped and then set back further inside the sinus cavity.
But regardless of the brow bone reduction technique, it requires a superior incision to perform. Whether a full coronal or a frontal hairline incision, the forehead tissues must be elevated and reflected down to expose the brow bones to do the required bone remodeling. In rates cases in some men a mid-forehead wrinkle line incision can also be used.
But another type of brow bone reduction can be performed and is far less commonly known. Tail of the brow bone reduction is done to reduce excessive lateral projection or to raise the vertical level of the supraorbital rim in the outer half of the orbit. What is unique about the outer half the brow bone from the inner half is that it is solid bone. The frontal sinuses only go over as far as a vertical line drawn up from the pupil.
The other unique difference with tail of the brow bone reduction is that it can be performed from below through an upper eyelid incision, hence the name transpalpeal brow bone reduction. This is the shortest distance to the brow bone tail and permits any needed amount of horizontal and vertical reduction.
Transpalpebral brow bone reduction has a variety of indications and is most commonly used in my experience in facial asymmetry. In the shorter or vertical deficit side of the face the superior orbital rim hangs lower. With orbital floor augmentation it becomes important to raise up the superior orbital rim at least an equal amount to improve brow bone and eyebrow symmetry. (with an accompanying browlift)
Dr. Barry Eppley
Indianapolis, Indiana