Q: Dr. Eppley, I am interested in forehead reshaping. I have mild to moderate metopic synostosis that was uncorrected as a baby. Because of this, the metopic ridge is prominent, starting about halfway down my forehead up to about 2″ behind my hairline. My entire forehead has the pointed appearance seen in trigonocephaly.
My question is: Is a reduction via bone burring enough to make my head more normally shaped? I will always have a… unique skull… but I’d like for it to be a little less unique! If not, is this something that could be corrected using a combination of bone burring and hydroxyapatite cement?
A: Thank you for your forehead reshaping inquiry. In the correction of the forehead, the bone burring has the least significance alone and would not produce a more normal forehead shape. In fact one could argue that the midline crest is the near normal projection of the forehead and it is the recession of the bone to the sides that is the bigger shape problem. Thus it is augmentation of the forehead using a custom made implant that offers the real improved shape to the forehead.
The problem with bone burring and the use of hydroxyapatite cement, which are both viable treatments methods is that they require a full coronal scalp incision from ear to ear to do. That is probably not an acceptable aesthetic tradeoff. A custom forehead implant offers a more predictable and symmetric shape result with a shorter scar to insert it.
Dr. Barry Eppley