Posts Tagged ‘brow bone reduction’
Tuesday, March 19th, 2013
Q: Dr. Eppley, I am a 22 years old male and am interested in the orbital reshaping/brow bone reduction process. I had a procedure done a year ago, it was a frontal sinus reduction. This procedure didn’t really accomplish much. I didn’t stress to the doctor the type of results I was after. I guess looking back, I have myself to blame. I have attached pictures which show most of what I’m unhappy with… the somewhat uneven/large orbital rim. I would like to smooth that down to create a simple and more attractive looking eye area.
A: Thank you for sending your pictures. Knowing that you went through a major frontal sinus reduction procedure, there must have been some miscommunication as to your outcomes. While I don’t know what you looked like before, my assumption is that what was achieved was some high frontal sinus/brow setback. But you were as much interested in the lower frontal and lateral setback as well. In your previous procedure, do you know how it was done? Was the bone taken off and put back with small plates and screws, wires etc?? That may have an impact on how well further reduction can be by hardware being in the way, scar tissue, etc. There is also the issue of
how much bone along the orbital rim can be reduced without entering the frontal sinus. This is the value of the frontal sinus osteotomy technique which overcomes this limitation. Orbital rim reshaping/brow bone reduction is more of a burring technique although some features of an osteotomy technique can be incorporated into it.
Dr. Barry Eppley
Indianapolis,Indiana
Tags: brow bone reduction, dr barry eppley, indianapolis, orbital rim reshaping
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Saturday, February 9th, 2013
Q: Dr. Eppley, I was interested in getting my hairline lowered as well as brow and frontal bone reduction. However I have a very thin hairline due to constant damage to my hair follicles. Any suggestions and how long after would I have to wait to get a separate surgery.
A: If I understand your question correctly, you would like hairline lowering/scalp advancement combined with frontal/brow bone reduction. The concern, which is both understandable and appropriate, is whether with a fine and thin hairline that you should have the procedure. The answer to that question would be based on what your frontal hairline looks like now (please send me a picture), how much scalp laxity you have and whether you were eventually planning on any hair transplantation along the hairline after the procedure. (as some people do for scar camouflage) The quality (hair density and pattern) of your frontal hairline determines how well the scar would do and its potential visibility. Your existing vertical forehead skin length and your natural scalp laxity determines how much scalp advancement/hairline lowering is possible and whether the result justifies the effort. Knowing that one may be considering the potential for hair transplantation later gives one more freedom to perform the procedure is someone with less than an ideal frontal hairline.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: brow bone reduction, dr barry eppley, hairline lowering, indianapolis, scalp advancement
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Friday, December 14th, 2012
Q: Dr. Eppley, I understand that recontouring of the frontal bone is a procedure that is not often done in male patients due to the scalp scar. The problem that I have is that the upper portion of my frontal bone protrudes over the supraorbital ridge. In addition to this, I have an evident asymmetry in the area of the superior temporal line on the left side of my skull. My question is would these two issues be capable of being addressing by burr and synthetic materials as appropriate, and as for the required incision, as an alternative to a coronal flap incision, would an incision on the back of the head be used so as to conceal the scar given the possibility of male pattern baldness?
A: In answer to your question about what type of incision may be possible in a male for brow bone and/or forehead surgery, the picture of a potential incision you have shown (the wrap-around occipital incision) is not one that can be used. While anything can be done on a drawing or on paper, it is impractical to use for brow bone or forehead surgery. To really reach this area and work on it adequately, the scalp and forehead tissues must be ‘flipped’ down to see the area. That incision is so far back that it would be difficult if not completely impossible to work under so much scalp tissue from so far away. This is more than just theory for me as I have tried such incisional approaches and can testify to the difficulties that they pose. The problem is not that you can not access as low as the brow bone area with am occipital coronal incision, it is that any bone modifications or material additions that one does becomes very hard to get them smooth or even at such a distance. And if you don’t have some assurance that a good aesthetic improvement can be obtained then that defeats the purpose of doing the operation in the first place. That being said, if the back end of the incision is moved up by 5 to 6 cms in the high occipital area, then it can be used for brow bone or forehead modifications.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: brow bone reduction, dr barry eppley, forehead augmentation, indianapolis
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Sunday, November 4th, 2012
Q: Dr. Eppley, I am interested in a variety if procedures including brown bone reduction, rhinoplasty, chin augmentation and correction of my chest which I think is a pectus excavatum deformity. I have attached a variety of pictures so you can see all of the problems. I would like to know what you think.
A: I have taken a careful look at your pictures and can make the following comments.
1) Your chest deformity is very slight and not a true form of pectus excavatum. Regardless of what it may be called, I see no surgical procedure that would be worthwhile. Given the mild nature of the sternal groove/depression, the only option would be to build up the sternum with an injection technique to avoid any significant visible scarring. The problem is that it would be virtually impossible to get a smooth result. Without such a result, you would end up with an equally distracting aesthetic problem.
2) Forehead/brow bone reduction is not an option for you due to the mild nature of the bossing and the need to have a scalp scar to do it. That is always a challenging problem in a male. The trade-off of a scalp scar is not a worthy exchange.
3) Your chin shows both a significant horizontal and vertical deficiency. Its amount of deficiency makes your nose look bigger than it really is. It is the one feature on your face that would make the most dramatic change. Because of these three-dimensional chin deficiences, a chin implant is not a good option as it only brings it forward. Only a sliding genioplasty can bring the chin forward and down which are the changes that you ideally need.
4) The only beneficial changes that I see in your nose is the tip. It could be made thinner. But I would not change the height nor the smoothness of the dorsal line. I would also not change the tip position by making it any shorter or have anymore upward rotation. In essence, a tip rhinoplasty is all that you need.
I have attached some computer imaging based on the chin and nose changes.
Dr. Barry Eppley
Indianapolis,Indiana
Tags: brow bone reduction, dr barry eppley, indianapolis, pectus excavatum repair, rhinoplasty, sliding genioplasty, tip rhinoplasty
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Friday, September 7th, 2012
Q: Dr. Eppley, I feel my brow is too prominent/large. I had one surgeon tell me only a full “sinus setback/type III” will be the only way to fix it. However, can the bones be modified/burred enough to make a difference? I want the side/profile to be more flat and less prominent. I feel my forehead profile is the only element that makes people look at me strangely sometimes and it makes me very uncomfortable. I read that the supraorbital rims can easily be reduced even with just brow remodeling. Is this true? I appreciate any feedback you can give me, even if it is that I am likely to only benefit from the aggressive sinus setback type of surgery. I just need to know if there is an adequate amount of change that can be achieved with some mild bone shaping and with soft tissue modification to effect a real improvement (not perfection, but more feminine appearance, in profile as well) or if I’ll have to do the full reconstruction. I know an x-ray is the only way to know for certain.
A: In looking at your photos, the brow bulge does appear to be from the frontal sinus. But whether that needs to be burred or setback by osteotomies will require a lateral skull film to best answer that question. In some cases in women, I have done a little burring of the brow bone prominence and building up of the forehead above it to create a smoother more convex forehead. That can be a very good alternative to setback osteotomies for mild amounts of brow bone bulging like yours.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: brow bone reduction, dr barry eppley, indianapolis
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Tuesday, August 28th, 2012
Q: Dr. Eppley, do you ever do a forehead burring/scalp advance/brow lifts without the sinus setback? I am a woman and my brow bones are not that big so I don’t think I need the frontal sinus setback.
A: Most forehead reductions in women are actually done by burring and not osteotomies/sinus setbacks. That is more of a male procedure in most cases. In women it is common to do a brow bone reduction by burring and/or forehead reshaping with a hairline advancement (scalp advancement) or a browlift. Seeing some photos of you would be helpful in determining which are the desired procedures.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: brow bone reduction, browlift, dr barry eppley, indianapolis
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Friday, August 17th, 2012
Q: Dr. Eppley, I am 24 years old and my brow bone gets getting bigger. Is there something I can do to stop it expanding? Why is it doing it? Can an incision be made on both eyebrows to perform procedure? What would be your best idea without doing a coronal incision? Can a cut be made in my eyebrow so you can burr it down. ( wouldn’t be much) Then somehow either inject a filler into the top part of my forehead to smooth out… what about some kind of implant for the top part of the forehead? Does that need a coronal incision to be placed in?
A: At your age, your frontal sinus development is complete and should no longer be expanding. That is a function of skull growth which is long over now.
An incision can be made along the eyebrows known as the ‘Open Sky’ approach. It runs along the upper eyebrows and crosses over the nose. While it can be done, it is an historic approach that has largely been replaced by the coronal incision. I am not so sure that wouldn’t be more obvious than the coronal incision quite frankly but I wouldn’t yet rule it completely out
The key question about incisional approaches is what exactly needs to be done to the brow ridge to reduce it. In the vast majority of cases it requires infracturing or an osteotomy of the outer plate of the frontal sinus bone. This can only be done through a coronal approach. Usually simple burring is inadequate BUT if one has just a few millimeters of bone that need to be taken down and the area above it is built up with cement, the eyebrow approach may be reasonable. That could be determined beforehand by one simple x-ray known as a lateral skull or frontal sinus film. That would tell us precisely how thick the frontal sinus bone is and how much can be reduced by simple burring.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: brow bone reduction, dr barry eppley, forehead augmentation, indianapolis
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Wednesday, July 25th, 2012
Q: Dr. Eppley, I have an weird forehead. It has that I mainly have a brow as a man and it also has horns (exotosis) I was wondering if you do such surgery to fix this/shave down my skull to get me a desired smooth forehead as a female should have. I also have a high hairline so I’m wondering if you can pull it down. How old do you have to be? I know 18+ but the skull doesn’t finish developing until what age? I am 20 so I don’t know if I am old enough yet. Also, can both surgeries be performed at the same time?
A: The skull is largely finished developing by one’s early teens, it is the facial bones below it that continue to develop until the late teens with the mandible finishing complete growth around age 21. Therefore, at age 20 you can have frontal/brow bone reduction without any concerns about growth implications. The only issue is how much the brow bones can be reduced given the frontal sinus which lies underneath it. That could be determined before surgery by a simple lateral skull film. The hairline advancement/vertical forehead skin reduction is done through a pretrichial incision. This also provides the exposure needed for the forehead and brow reduction so, by necessity, these two procedures would be performed at the same time.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: brow bone reduction, dr barry eppley, forehead reduction, hairline advancement, indianapoiis
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Sunday, July 22nd, 2012
Q: Dr. Eppley, Hello, I’m a 19 year old male. I recently cut my hair short and to my surprise, I have a very Neanderthal-esque brow ridge. It doesn’t stick out as far as some people from pictures I’ve seen, just a couple of millimeters probably. I was wondering if there was any alternatives to plastic surgery for this? Can small amounts of pressure be applied to the area over an amount of time to reduce the appearance, or anything similar? Obviously at such a young age I don’t want to resort to plastic surgery, but I dislike the appearance that my brow ridge gives my face. Thanks in advance.
A: The pneumatization or expansion of the frontal sinus cavity creates the prominence of the brow bones. This is not bone growth but bone stretching due to underlying air expansion. This is why the brow bones, the bigger they are, are very thin often only being a few millimeters in thickness. The development of a brow bone prominence or bossing is genetic and can not be modified once established by any external pressure or molding. If it is too aesthetically excessive, it requires surgery for brow bone reduction.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: brow bone reduction, dr barry eppley, indianapolis
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Friday, June 22nd, 2012
Q: Dr. Eppley,I am female, 35, interested in brow bone shaving. My brow bone is a bit too thick, and I feel it looks a bit masculine. Is there any risks to shaving the bone in the glabella area? Would this make the bone there too thin and easier to fracture in the event of an injury? I don’t need too much shaved, but wondering if even a bit of shaving is risky. Thank you.
A: The issue with brow bone shaving is not one of real medical risk. The only issues with brow bone reduction are two-fold. First, you need a scalp incision and turn down flap to do it. So there will be a resultant fine line scar in the scalp. Secondly, and more relevant to your question, shaving the brow bone has the risk of burring right into the frontal sinus cavity. Most of the brow prominence is not composed by bone at all, but by air from the sinus cavity undermeath. How significantly one can burr down the brow bone depends on how thick the outer cortical table of the frontal sinus is. Often times it is no thicker than 2 to 3mms. The glabellar area, the part of the brow bone between the eyebrows, often will have no frontal sinus cavity underneath so it may be able to be reduced much more.
For these reasons, it is necessary to determine a patient’s eligibility for brow bone reduction knowing in advance the location of the frontal sinuses and measuring the thickness of the bone. This can be done with simple plain x-rays taken from the front and side views. For some patients, brow bone reduction by burring is adequate (minority of patients), but other patients need to have done an osteoplastic bone flap technique due to their thin outer bone covering of the sinus.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: brow bone reduction, dr barry eppley, indianapolis
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