Brow Bone Reduction Revision

Q: Dr. Eppley, I would like to discuss forehead remodeling for a brow bone reduction revision. Attached is a photo from your website to a more masculine forehead. I would ask for the exact opposite. To do that, my angle between the forehead and nose would need to be altered. In addition, my frontal sinus would need to be reconstructed to alter shape and slope of forehead to make more feminine. You can see how protruded it is in my x-ray. Burring down the bone is not appropriate as my original surgery performed did that and it was not successful.

Unfortunately, from that surgery, my surgeon removed most of my frontalis muscle as outlined as the “diamond shape.” I would like something added to hopefully contribute to a more rounded forehead but also to decrease the hollowness when I lift my eyebrows. I am leaning more toward fat injection because it is the least invasive and you

could also take fat from my neck as I don’t have a well defined jawline and this bothers me a lot. I am basically asking you to do it to alter the forehead slope and decrease the visibility of the “diamond.”

A: With your frontal sinus anatomy, a burring reduction was never going to be successful so that is a peculiar brow bone reduction technique that was chosen. Even more peculiar was the removal of the galea/frontalis muscle of your forehead creating an expected soft tissue indentation along the entire excision pattern.

But moving forward an osteoplastic bone flap method is now needed to create a more significant brow bone setback. Managing the forehead soft tissue defect is more challenging. While I would agree that fat injections as an isolated procedure would be reasonable, that is not possible to do during an open brow bone procedure as where the fat needs to go is completely open. The only thing that could be done during the open procedure is to remove a large galeal graft from the scalp behind the frontal hairline incision.  The other option is to lay in a thick layer of allogeneic dermis, like Alloderm, as a composite collagen graft. Otherwise fat injections would have to wait 3 to 6 months after the brow bone reduction procedure. Also with fat injections your neck would not have remotely enough fat to do the procedure. It would have to be harvested from elsewhere, usually the abdomen.

Dr. Barry Eppley

Indianapolis, Indiana