Brow Bone Reduction
Q: Dr. Eppley, I am interested in brow bone reduction. Since high school I’ve had a prominent forehead and found it hard to accept. Now ten years later I have decided to do something about it. I have read on your website and checked out the various methods and then decided that the only method that would work for me is directly through the forehead because my hairline is receding. I don’t really have any deep forehead wrinkles but it is the only option. I have attached pictures for your review.
A: Thank you for sending all of your pictures. In regards to the type of forehead reshaping you need the question is whether this is a brow bone reduction (to bring the brow bones back to the level of the upper forehead) or whether it is to build up the forehead above the brow bones to correct its slope. Just based on forehead aesthetics for a male, I am assuming it is the latter. A custom forehead implant is made from a 3D CT scan.
Conversely brow bone reduction can also be done. In your case the brow bone reduction may only be a burring of the most prominent portion of the outer table where it bulges tyhe most.
You are correct in that a limited horizontal forehead incision would be the only reasonable incisional approach. Fortunately custom silicone implants are very flexible (until they situ against bone) and thus can be inserted in a rolled fashion and then unfurled once inside. That at least will keep the horizontal forehead incision more limited, perhaps in the 4 to 5 cm length. The location of the incision would be determined by raising your eyebrows and seeing where the eventual deepest horizontal crease will eventually be. Placing it there will usually lead to a pretty good scar result. The exact same type of incision would be used for any form of brow bone reduction as well.
Dr. Barry Eppley