Brow Bone Recontouring

Q: Dr. Eppley, I am seeking brow bone recontouring from a brow bone fracture that I had two years ago. This was never fixed and had left me with a big indent in my brow. Can this be fixed?

A: Thank you for sending your pictures and the x-rays. What you originally had is a depressed frontal bone fracture that involved the frontal sinus and supraorbital rim. It remains as a displaced forehead fracture but a healed one at this point. It is no surprise that a neurosurgeon would want to do a craniotomy to lift out all the bone and get it back into anatomic position through a full coronal scalp incision. This would certainly be the standard neurosurgical approach. But I can understand why that would not be that appealing to you at this point. The alternative treatment strategy would be a brow bone contouring approach. Leave the bone where it is and apply an hydroxyapatite cement over top of the entire depression to recreate a much improved forehead contour. This is an appropriate strategy as long as there is no air leak from the frontal sinus or a CSF leak into the nose. (which I am sure there is not)(

The only debate about this contouring approach is the location of the incision. It certainly makes access easier and a more thorough recontouring can be done with the wide open exposure of the full coronal scalp incision. But that incision/scar may want to be avoided. The alternative incisional access is through one of your existing horizontal forehead wrinkle lines. This avoids the larger scalp scar. I have done this many times for forehead cement application and brow bone reduction in men. It is usually a scar that heals quite well since it is in a natural skin wrinkle which is only going to get more pronounced with time anyway.

Dr. Barry Eppley
Indianapolis, Indiana