Does Brow Bone Reduction Surgery Need 3D Computer Planning?

Q: Dr. Eppley,I have a few questions for Dr. Eppley.  I came across this youtube video showing a type III forehead reduction being performed, and it highlighted the challenges with dealing with the frontal sinus.  Could you ask how you will handle it? Does the surgical facility have a live CT and planning software similar to what was used in the youtube video above?

Finally, I attached some pictures I took when Dr. Eppley marked where he thought he could shave down to without doing a Type III flapback procedure. I now realize CT images are reviewed to see how much bone is available for shaving – is this limited by the frontal sinus? If so, after reviewing the CT footage, does he think those markings are still accurate?

A: In answer to your brow bone reduction questions:

1) I am not sure what is meant by the ‘challenges’ of an open Type 3 brow bone flap setback procedure. Brow bone surgery essentially its frontal sinus surgery.

2) In today’s world as much of FFS is done through insurance new technologies have been developed using the patient’s 3D CT scan to help ‘guide’ the surgery.  To those of us who are very experienced in this surgery we feel this is not worth the added expense. ($5,000 +) But if insurance is paying for the costs of such technology then why not get it. It is very cool technology and it is done from the same engineers from which all of my custom implants are made, so I am very familiar with it. But in the aesthetic patient who is paying out of pocket one has to put a value on what it brings to the surgery. (i.e,, does it make for a better outcome)

3) I have your 3D CT scan from your previous surgery so the brow bone reduction prediction by imaging has an anatomic basis for it.

Dr. Barry Eppley

World-Renowned Plastic Surgeon