Custom Forehead Implant
Q: Dr. Eppley, For my forehead augmentation I have been unsure whether I should use bone cement or just do a custom forehead implant as we originally discussed. I would prefer a custom forehead implant, but I know that can’t be done at the exact same time as the orbital rim shaving as it needs to be made custom from the skull model. But rather than do it on two separate occasions, I thought of a possible option… I thought about coming to see you for the orbital bone shaving, temple brow lift, and then immediately after this operation (like the following day) get a CT scan done and then get a custom forehead implant made, and then after a week or two weeks (however long it takes for the implant to be made) then get the forehead implant placed on to the forehead? This would mean I could get both the orbital rim shaved down, making the outer area of the eyes more open, but also get the angularity and shape I hope for with the implant. And do it all in one visit. Also it would mean that the incision wouldn’t have a proper chance to heal so maybe easier to go back into the coronal incision without resulting in much scar tissue or risk for stretching etc (which may happen if done 6 months later for example)? What do you think about that?
A: There are two ways to achieve your forehead goals in a single visit.
1) In designing a custom forehead implant the amount of orbital rim shaving is factored into the design. Since the implant would not be sitting over the orbital rim reduced area this makes it a very viable approach.
2) Use bone cement at the time of orbital rim reduction. This is done under direct vision and it could be shaped based on what is seen.
Either way I see no reason why orbital rim reduction and forehead augmentation would need to be two separate procedures. I have done this combined forehead approach many times.
Dr. Barry Eppley