Q: Dr. Eppley, I’m interested in endoscopic/minimally invasive forehead contouring or implant. My concerns are twofold: the “dented” look of my forehead in the area above the brow ridge (more prominent on the right side), and the “sharp” point in the middle of my forehead where the bossing ends. I am aware of the challenges that hair loss poses for surgical options but I wanted to stress that I am open to any and all options available to improve the appearance of my forehead in overhead and other unflattering lighting.
A: Thank you for sending your pictures and excellent diagrams of your concerns. The fundamental cause of your forehead concerns is the sharp contract between the amount of brow bone bossing (frontal sinus hypertrophy) and the shape of the forehead above it. In an ideal world the combination of brow bone reduction and augmentation of the forehead above it would be done. But your frontal hairline location and lack of hair density, as you have stated, create considerable aesthetic scar issues with the traditional approach to it of a hairline or scalp incisional approaches. It impossible to do such a technique through a mid-forehead incision in a horizontal wrinkle line, and I have done so numerous times in men, but I still remain hesitant in doing so.
The most limited scar approach to your forehead contouring is to accept the brow bone position and augment the near circular areas above it that create the very obvious forehead indentations. This could be done through either the application of bone cements or small custom implants placed through an ‘endoscopic’ or limited scalp or forehead incisions.
Dr. Barry Eppley