Posts Tagged ‘forehead reduction’
Sunday, January 15th, 2012
Q: Dr. Eppley, I am hoping to reduce the size of my bulging head and brow bone to get an even and a more natural look. Please take a look at my pictures and tell me what you think.
A: There is no question that you have a significant forehead bulge or protrusion. In looking carefully at your pictures you can see a narrowing behind the forehead bulge running down the sides of the skull exactly where the coronal sutures would be. This suggests the reason for your forehead bulging is some variant of coronal craniosynostosis, probably a partial craniosynostosis deformity. Whatever the reason does not change how you might approach forehead reduction. While the most effective procedure would be removal and reshaping of the entire forehead bone flap and the skull bones behind it, this type of craniofacial surgery can only be done in infants and not adults. This is due to the inability to mold bone in an adult skull. Therefore, the only option as an adult is whether external bone reduction by burring would make a significant difference. That question can be answered by plain lateral skull x-rays. This x-ray would allow a measurement to be made as to the thickness of the forehead bone and, more specifically, the thickness of the outer cranial table and underlying diploic space. If up to 5 to 7mms of forehead bone can be reduced over the entire forehead, this may make enough of a difference to justify this approach to forehead reduction.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, forehead reduction, indianapolis
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Sunday, January 8th, 2012
Q: Dr. Eppley, I just had a quick question regarding the forehead lowering procedure. I want to get my forehead lowered however I have a “Y” shaped vein that runs right down the middle of my forehead. Is it still safe to perform the surgery with this and have you ever personally encountered this?
A: Many people have prominent veins in their forehead that undergo browlift and hairline type procedures. Because the veins are in the subcutaneous level of the forehead tissues, they are out of the plane of dissection which is at the deeper subperiosteal level. So they do not pose any ‘risk’ for a hairline lowering/forehead reduction surgery. If the vein(s) crosses into or from the frontal hairline, it will be tied off or cauterized in a hairline advancement as it will be encountered in the dissection from the skin down to the bone. Either way, veins are not an issue in any type of forehead surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, forehead reduction, hairline lowering, indianapolis
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Wednesday, November 16th, 2011
Q: Dr. Eppley, I am interested in a forehead reduction. I have attached two photos of my forehead for your review. I hope these are enough. As you can see my forehead is massive and it gets me down !! Can you help? Is it always successful? Is there much recovery?
A: Thank you for sending your pictures. What you refer to as a massive forehead is one that is very long. I would estimate that the measurement between your eyebrows and the edge of your frontal hairline is at least 7.5 cms. If the forehead length in females is greater than 6.5 cms it is considered too long. This can be improved with a frontal hairline advancement, also known as a forehead reduction. This is where an incision is placed along the edge of the frontal hairline, the scalp behind it is loosened, lifted and brought forward, and the forehead skin underneath then removed. The amount of forehead skin removed is the amount that the vertical length of the forehead is shortened. Generally, 1.0 to 1.5 cms can be reduced in the middle of the forehead. There is less so taken out from the sides where it tapers into the upper temporal area. This is a very effective and successful procedure. Forehead reduction is an outpatient procedure that takes 90 minutes to do under general anesthesia.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, forehead reduction, hairline advancement, indianapolis
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Sunday, November 6th, 2011
Q: Dr. Eppley, I have a question about the postop healing process for a forehead reduction/hairline advancement. It has been just about 2 months since my surgery and my scalp is still not healed. I have some large areas of scabbing over the incision sites and don’t know but it seems like they should be healed by now. I don’t know if I am doing something or taking some medication that would slow this healing process. Please just let me know if this is normal I can also send you some pictures if you would like.
A: It is certainly not common to have a forehead incision that is not completely healed after two months. The scalp is such a well vascularized tissue that it is hard for any portion of it to not heal unless there is a good reason. Most likely, these non-healing areas represent spitting sutures. If you look close at them after removing the scabs, you may see little white threads which are dissolveable sutures sticking out. Many times along the hairline the body will spit them out long before they will ever dissolve. There presence at the incision lines now serves as a chronic source of infection which appears like a pimple or small draining sinus. This is a common problem in many body areas and the hairline is no exception. If you can pick out those white sutures you will remove the source of irritation and the areas will go on to complete healing. I have seen this wound occurrence many times after pretrichial browlifts and forehead reductions.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, forehead reduction, hairline advancement, indianapolis, scalp healing
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Tuesday, October 25th, 2011
Q: Dr. Eppley, I don’t like having a large forehead. I would like it reduced by at least an inch. I understand by having the eyes done that will also can help. I also hate how one eye brow is lower than the other one. I am sending pictures from the front and side views so you can what I mean.
A: Thank you for sending your pictures. I can see the three issues of concern, your very long forehead, eyebrow asymmetry and extra skin on the upper eyelids. Most frontal hairlines (forehead reductions) can be advanced close to an inch, depending upon how mobile one’s scalp is after it is freed up. The advancement is always greatest in the middle and tapers out towards the temporal hairline. To improve your eyebrow asymmetry, more skin would be taken out on the left side than the right as it tapers outward. The upper and lower blepharoplasties would be done in the conventional fashion with skin and fat removal. The combination of all three would make for quite a periorbital and forehead rejuvenation effect.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, forehead reduction, hairline advancement, indianapolis
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Tuesday, May 3rd, 2011
Q: Hello. My hairline is kind of far back. I would say it is about 2 cm too far and it is really making me look odd. I have attached a video which captured it pretty good as well as some photographs. Here are my thoughts. Every cm. down would be a great thing for me, but as you can see, I also have some natural receded hair in the corners of each side. Could this look weird or odd in case of bringing the hairline down a bit or will they also be brought down? Also, I don’t mind the ehighht of my forehead. It is just that the hairline sits so far back.
A: When doing a hairline advancement, the entire frontal hairline is moved although the greatest movement is in the middle. Your issue for a forehead reduction is that you are a male and young. Since you can not possibly predict how stable your frontal hairline will be for the rest of your life, the fine line scar from the procedure along your existing hairline may not always be at the very edge of your hairline. This raises the very high probability for most men that the scar one day, sooner or later, may be visible in front of one’s hairline. This is why hairline advancements (forehead reductions) are rarely, if ever, done in men
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, forehead reduction, hairline advancements in men, indianapolis, plastic surgery of the forehead
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Friday, April 1st, 2011
Q: My forehead sticks out from the side is there anyway you could make it flat and look at least normal? I have attached s side view of my forehead so you can see how far it really sticks out.
A: Thank you for sending your picture. It does show a fair amount of convexity to your forehead. The amount of convexity could be reduced but it can not be made to be flat. The bone thickness will not support that much reduction.
Here is a computer image of what I think is the best that could be achieved with a burring reduction of the forehead bone. There is one way to know absolutely for sure how much reduction can be done and that is to get a simple lateral skull film x-ray. On that x-ray the thickness and, most importantly the thickness of the outer cranial table can be seen. The skull (forehead) is composed of three layers; an inner and outer hard cortical bone layer in between which exists a softer marrow diploic space. The amount of horizontal reduction of the forehead is limited by the thickness of the outer cranial table. It can only be reduced until one gets close to the diploic space. Measuring that on the x-ray could show how much the forehead could be reduced in thickness. A tracing of the before and after cranial contour could then show you the exact profile change that could be achieved.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, forehead bone burring reduction, forehead reduction, indianapolis, plastic surgery of the forehead
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Friday, March 18th, 2011
Q: I am wanting to get my forehead fixed. It just never grew in right and I have been made fun of since I was a kid. Photos may not look bad but I have been called horn head, hell boy, and square head all my life and I just want it to look a little better. I have two prominent ‘horns’ for lack of a better word on my forehead. I don’t know if these are just bone growths or my brain sticking out. They feel hard though. I have attached a picture so you can see them. Can these be burred down or something to make them look better?
A: Based on the one picture that I could see, it looks like you have two bulges on the sides of your forehead creating that look. These are very much like larger osteomas. The skull is thicker in these bulging areas. Reducing the bony bulges is actually fairly easy by burring them down to make the forehead less square and more round. The trick to it, however, is getting there to do it. The best approach would be a coronal (scalp) incision across the top of the scalp but that resultant scar (fine as it is) may not be a good choice for a male.The other approach is an endoscopic one where much smaller incisions are used. The access is not quite as good but I should still be able to burr down the prominent areas.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, forehead reduction, forehead reshaping, indianapolis, plastic surgery of the forehead
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Wednesday, March 9th, 2011
Q:I would like to ask you some advise. I have a high natural hairline that makes my forehead look bigger. I don’t have problem of losing hair. I would like to have a hairline lowering, but I don’t know how to choose between a forehead reduction and a hair transplant. With the forehead reduction I will have a quick result and after seeing some pictures on internet the result looks great. The bad point is the scar and I would like to know if this procedure can have a bad consequence for the future. For the hair transplant I would like to know if the result can be natural, I have long and dense hair. I have attached some pictures for you to see.
A: Thank you for sending your pictures. I don’t know if that is the standard way you wear your hair or whether you were doing that just for the pictures. (I’ll assume you were doing that just for the pictures) You have a very good hair density and a relatively full hairline pattern. I really think you could go either way with a hairline advancement or hair transplants. each has their own advantages and disadvantages for you. Hair transplants will have no hairline scar but I doubt you can get the density of your natural hair down to 2 cms from your existing hairline. You certainly won’t be able to do it in one session. If for whatever reason you don’t like the transplants then that effort will be wasted by doing a hairline advancement after. With the hairline advancement, you will get a well matched hairline density and pattern but at the expense of a very fine line scar.
My thoughts are that the hairline advancement is the best initial approach. Because…if the scar is too prominent it can be easily covered up with some hair transplants later. The reverse is definitely not true.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, forehead reduction, hairline advancement, indianapolis
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Sunday, January 30th, 2011
Q: For my bulgy forehead, is it possible to burr down the forehead and then do a forehead/eyebrow lift at the same time, just removing the extra skin? The reason I ask is because my head is misshappen and my hairline is too high. I want my hairline to be lower so burring down some of the forehead and then making and eyebrow lift would help alot. After that is done I was going to get a hair transplant on my hairline to cover up the scar. Does this sound like it will work? Will it work if I get a hair transplant over the scar and can I do the eyebrow/forehead lift thing?
A: Your approach to a forehead or frontal contouring is conceptually correct. While I don’t know exactly where your exact hairline is now or what its shape is, making a scalp or coronal incision there allows one to access the forehead area. Probably about 5mms across the forehead bulge can be taken down. A browlift can then be performed and the redundant skin removed at the scalp incision line. This will shorten the perceived length or height of the forehead skin. Thereafter, no more than 3 to 6 months later, a hair transplant can then be done to put a camouflage to the scar. Such a scar in the scalp can often heal remarkably well due to the uniqueness of hair-bearing (or past hair-bearing) scalp skin.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: browlift, dr barry eppley, forehead reduction, indianapolis, plastic surgery of the forehead, scalp scar
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