Custom Forehead and Brow Bone Implant
Q: Dr. Eppley, I am looking to get augmentation of the brow ridge/supraorbital rim. I also have a backward sloped forehead which I was hoping to make more vertical at the same time. I have consulted with another surgeon who told me that my lack of supraorbital rim projection extends to the lateral orbital rim too. So I was wondering whether it would be possible to design a custom implant to cover all three of those areas at once? A couple of other issues are these;
– It appears as if my supraorbital rim is not only under projected but also that it sits at an upward angle ‘away’ from my eyeball itself. Is it possible to fashion an implant that both angles downwards and sits lower down on the supraorbital rim to ‘surround’ the eye?
– The same issue seems to be apparent with the lateral orbital rim in that it sits too far away from the eyeball. Can the same be done here as with my question above?
– Not only is my forehead backward sloping and sagitally underprojected, but it is also horizontally convex. The sides of my forehead sit too far back relative to the centre of the forehead. Is this a fixable issue?
A: Using a custom forehead and brow bone implant concept, it can be designed to any desired shape and dimensions. The key issue is not whether an implant can be designed to accommodate your aesthetic desires, but whether your tissues can adequately stretch to accomodate the desired augmentation. This is of a particular issue as one tries to create augmentation on the lower aspect of the brow bone. Besides there being the supraorbital nerves (responsible for feeling sensation of the forehead) which exits through the brow bone and can become injured when an augmentation drops below the brow bone, this is also a brow bone area that is hard to expand as the tissues are very tight.
The other aesthetic issue is that it is potentially problematic when the forehead augmentation crosses the temporal lines at the side of the forehead. Unlike the bony forehead, the sides of the forehead (or the upper temporal region) is muscular and not bone. Any augmentation that crosses into this area can create an unnatural line of demarcation. (the temporal line is a natural line of demarcation)
In short, a custom forehead and brow bone implant can be designed to meet most of your aesthetic augmentations. But there are some aesthetic considerations that may not allow every aesthetic/forehead desire to be met.
Dr. Barry Eppley