Can A Custom Brow Bone Implant Lower The Eyebrows?

Q: Dr. Eppley, In one of your blog posts you state: “many models display a very strong or exaggerated brow bone appearance. It borders on being an almost angry appearance but is better anatomically described as an ultra low brow bone projection with near complete coverage of the upper eyelids. While I frequently get requests for such a brow bone augmentative change, I have to advise such requests that is almost always not possible. This is due to the fact the soft tissues of the eyebrows is very tight and can not be driven down below the existing brow bones unless these tissues have been first expanded before a brow bone implant is placed” 

I assume what is meant by this is that lowering the solid prominence brow ridge is possible, but it will not move the eyebrows into a lower position, creating the angry looking appearance many patients desire. 

Are you saying that it is rarely possible to create a lower set, bony prominence, or are you saying that it is rarely possible to get the eyebrows to move along with the prominence when creating a lower set brow ridge. 

It seems like if a patient wanted to pursue a lower set brow ridge, without significantly moving the eyebrows, then the soft tissues of the brows would not be a limiting factor in that sort of augmentation.

A: Your understanding of the brow bone and eyebrow movement issues is correct. While brow bones can be augmented such that the inferior level of the supraorbital rim is lowered, and this is regularly done, there is no guarantee that the overlying eyebrows will follow down with it. At least not to the extent that some patients desire it to do so. But for the patient where downward movement of the eyebrows is not important, lowering the horizontal projecting level of the brow bones can be done.

Dr. Barry Eppley

Indianapolis, Indiana