Brow Bone Augmentation
Q: Dr. Eppley, I am writing to you because you seem to be the de facto expert when it comes to brow ridge augmentation. This will be a rather lengthy and complicated post, and I do hope to be able to get your expert advice.
Basically, I had fat grafting done to my brow ridge 3 years ago, but the issue is that the end result was asymmetric brow ridges (my right brow has slightly more remaining fat than the left). Not only that, the central brow region (radix/glabella) was not augmented enough. As a result of this, I sought a more permanent way to augment my brow ridges, and I had a PMMA forehead/brow ridge implant placed earlier this year. While this did give me more pronounced brows and fixed the issue slightly, it still hasn’t solved some of the contouring issues caused by the fat graft.
I have since been getting fillers to correct the defect, but it is cost prohibitive and I’m not a fan of getting repeated injections to this region due to the small but catastrophic risk involved.
Anyway, I’ve been researching custom brow ridge implants, and I have a few questions:
1) I understand that they are customized to fit on the underlying bone. Would having an existing PMMA implant be an issue?
2) Could the outer side of the implant (the side that gives the soft tissue push) be customized to accommodate for the previous fat graft? Again, would the PMMA implant interfere with this design process?
3) The one area that the PMMA implant did not augment were the sides of my forehead and I was told that it is because PMMA can not be placed too far out near the temples. Hence, could a silicone implant extend to the temples to create a wider and more ‘rectangular’ forehead?
I’m sorry for the trouble, and I’m sincerely hoping that you will be able to help me.
A: Thank you for your inquiry. The fundamental question you are asking is whether a custom silicone brow bone/forehead implant can be placed on top of the existing PMMA implant and whether such a brow bone implant can extend up onto the forehead and out past the anterior temporal lines onto the temporalis fascia. The simple answer is yes to both questions. My only additional insight is why bother to make a custom implant to fit in top of the existing PMMA implant. if you are going to make the effort to make a custom brow bone-forehead implant, you may as well remove the PMMS and make the entire augmentation out of one implant material.
Dr. Barry Eppley