Brow Bone Reduction Surgery for Prominent Brows

Q : I would like my brow bones reduced. I am now 20 and until about 12 years old my brow areas looked normal as best as I can remember. Since then they have continued to grow, or at least seemed to, to the point that I look like a Cro-Magnon man. My parents took me to get evaluated by an endocrinologist around age 14 or 15 to see if there was some reason and to make sure I did not have acromegaly or some other hormone problem. Those tests were normal. I feel like a freak with the way I look. How is this surgery done?

A: Prominent brows are not due to excessive bone growth of the forehead per se. Rather it is due to the overdevelopment or pneumatization of the frontal sinuses. The frontal sinus is an air-filled space between the inner and outer bone surfaces of the forehead brow bone. They empty into the lower portion of the nose through long ducts. Sometimes they exist as two separate cavities above each brow. Other  times, they connect across the middle and are just one big frontal sinus.

The frontal sinuses do not even begin to develop until age 8 or older. They do not stop forming until well after puberty. When the airspace gets too big, it causes the bone on the outer side of the sinus to bulge out. Why some people’s brows remain flat and others ’overdevelop’ is not known. While there can be a medical reason, such as a pituitary tumor, most cases are idiopathic. (they just happen for no apparent reason)

Brow bone reduction surgery involves taking off the bulging outer plate of bone and reshaping it. During the operation, the cavity of the frontal sinus is widely exposed and the reshaped outer plate of bone is put back with tiny plates and screws. While this sounds like a gruesome operation, it is not. In many ways, it is a glorified brow lift using the same scalp incisional approach. It is the same operation as a frontal sinus fracture repair.

The sticky issue for men is the need to create a fine line scalp scar behind the frontal hairline. Based on hairlines and density, this may be a concern for some men.

Dr. Barry Eppley