Can The Width Of The Forehead Be Increased With Bone Cements?
Q: Dr. Eppley, I have a question about forehead width. I have quite prominent contours at the borders of my frontal bone which are wide at the top but then taper down to become very narrow at the bottom, where they join with my orbits. I am wondering if there is a way to build up these contours to make my forehead appear slightly broader/squarer as oppose to triangular. I have attached a diagram of a random skull below, to illustrate the area which I would like to augment, and the desired effect. (Red is original border, blue is desired outcome).
I also have a question about the materials. I would ideally like to use a bone cement for this procedure as I believe it might be cheaper and I am comfortable with a larger incision if it would save costs. Would this be possible? Or would the only way to do such an augmentation be to use custom silicone implants? Thank you for your help.
A: When you expand the lateral border of the temporal line of the forehead you have to have the implants placed on top of the deep temporal fascia, not underneath the temporal muscle. Thus this can not be accomplished by bone cements as they simply can not be put on top of the fascia without a full coronal incision and would have an abnormal edging to them. You can’t hand make such a shape very predictably and have it also be perfectly symmetric.
Besides the aesthetic issues and need for a coronal scalp incision, it is also not less expensive. While the cost of the raw materials does differ it also takes 3X as long to do a bone cement forehead augmentation as does a custom forehead implant….which more than wipes out the lesser cost of the PMMA bone cement. (HA bone cements can not be placed on soft tissue as they crack and break apart)
Dr. Barry Eppley