Q: Dr. Eppley, I have had three forehead contouring procedures starting with a PMMA forehead augmentation ten years ago. After some time a ridge across my forehead became more pronounced and I had two more procedures which involved removal of the PMMA implant and some adding of hydroxyapatite cement. I am lnow eft with strong indents in both sides of upper forehead, a lack of any real brow bones, and eyebrows became more propped up in corners. I would like to fill in and smooth the upper forehead and possibly build up the brows, which I think would improve/flatten eyebrows by getting them closer to their original position. I am wondering with three procedures done, and scar tissue removed, would I have enough elasticity to attempt to do this. I would love to not open the coronal scar and try to utilize less invasive methods. However, I understand the need to do this for better access to the forehead and brow bones. It has been five years since the last procedure. (second and third procedure were performed over a 6 month period with the same surgeon)
A: With having multiple forehead contouring procedures done you are correct in being suspect of how your forehead tissues would respond to further efforts at augmentation/expansion. That tissue issue is overcome, should it exist, with galeal releases done on the underside of the scalp flap. Between the need to very specifically apply further forehead augmentation materials and to potentially need to release the galea, an open approach using your existing coronal incision would be required. Limited incisional techniques in the face of your forehead circumstances is a setup for additional forehead contour issues. In essence the result will only be as good as what the surgeon can see. As you have observed in forehead augmentation even the slightest contour issue is eventually seen as the forehead tissues contract around it. It is surprising that even thick forehead tissues eventually reveal even the slightest irregularity beneath it.
Dr. Barry Eppley