Custom Forehead Implant

Q: Dr. Eppley, I am a male with two enlarged bony frontal sinus and recessed forehead above it, creating a dramatic big V above my mid brow. When I was younger I would grow my hair to cover it, but now that my hairline has receded, I can no longer hide these horrible forehead bumps and lines. While I’d like to get it burred and smoothed, I am horrified of the thought of a huge hairline scar. My forehead slopes back quite a lot and I would like to know if a custom forehead implant can be inserted to cover it with minimal scarring. Please find photos of the my face. The sinus bumps can be seen clearly in these, creating a V shape depression toward my widows peak. It is really obvious when I am thinner and when the sun casts shadows across my face. Because they are so close to the centre of my forehead, that they tend to make my forehead look narrow and my face thinner and longer when viewed front on and make it look like I’m always frowning unless I raise both my eyebrows. I have considered many options including fat grafting, fillers, botox, implants and of course full forehead recontouring. When I am overweight, the extra layer of fat in my face tends to make them a little less obvious, but at the moment I am very thin and they are always visible.

A: Thank you for sending all of your pictures. You do not really have brow bone protrusion and your brow position is actually good for a man. What you have is a central forehead indentation/recession which makes you think you brow bones are bigger than they really are. I have seen and treated such cases just like yours before. The best and most effective mechanism is to make a custom central forehead implant that fits right into the depressed area. I have attached a custom forehead implant design from a near identical case like yours. (yours would be more V-shaped) This is slipped in through a small incision just behind the hairline. It is the best approach because it is permanent and is custom made to augment the exact area of deficiency. This is a very straightforward procedure to do with very minimal recovery. The key is in the implant design which is made from a 3D CT scan of your forehead.