Q: Dr Eppley, I just read a reply you wrote to a patient inquiring about forehead and orbital rim with either implants or hydroxyapatite paste to which you reply that Kryptonite Bone Cement would be a better option. I want to get your opinion on which material is the best choice for filling out the outer brow bone area(just very slightly). I’m asian, I have eyelids and round shaped eyes but my brow bone looks very weak, which makes me look tired unless i wear eye shadows/shading which I think have lead to my eyelid skin aging prematurely. My eyelids have started looking a bit saggy and I’m only in my late 20s. I want to have the appearance of having more developed brow bones (which looks normal on an asian person) i think this should also help keep my lids from sagging. I want to know if Kryptonite Bone Cement would be a good option for the browbone in my case? Or should i try something else? I’m also considering fat grafts. Please get back to me and let me know what you think is best. Thanks very much.
A: When it comes to brow bone augmentation, it is my opinion that it is always better long-term to add to the bone with a material of similar hardness…provided that the trade-off to doing it (incisional approach) does not leave any significant scarring. Fat injection grafting is a reasonable option nd it does offer simplicity and ease to do with a natural material. (fat) But how volume will stay and what its shape will be is not always predictable.
You have said one key statement in your inquiry…‘filling out the outer brow bone area’. It is critically important to know what specific brow area one wants to augment. If it is just the outer two-thirds or tail of the brow, then that could be done through an upper eyelid approach and adding hydroxyapatite paste. That would by far be the best way to do it and is very straightforward. If one needs the entire brow augmented, then I would use an endoscopic approach with Kryptonite bone cement. By this approach, it could be injected and then molded under endoscopic guidance.
Dr. Barry Eppley