Combining Hairline Advancement and Brow Bone Reduction

Q: Dr. Eppley, I’m in the list waiting to my scalp advancement and brow bone reduction and other procedures. My questions are about this 2 i mentionx today only want to reafirm with the first goals: 

– Scalp advancement with the maximun advance as i ask before using the technique one dr name frost (a minimum advance of 3cm at least).

– You tell my the burring technique can get the amoung of reduction of brow bone protusions (i measure the reduction like 4mm)

Thank you soo much!

A: In answer to your hairline advancement and brow bone reduction questions:

1) The goal of almost every frontal hairline advancement is the maximum of whatever the scalp elasticity will allow. It is very hard, and I have never seen it, where the frontal hairline is advanced too much or makes the forehead too short. The technique that is used in every case that I have ever done over the past two decades is what is decribed in the ‘frost’ technique. There is nothing new or novel about that method as that has always been the way it had been done. That being said how much hairline advancement you can get can not be precisely predicted before or guaranteed. In the end the inherent elasticity of your scalp plays as much a role as any technique used to move it.

2) With the burring technique the maximum amount of brow bone reduction is determined by the thickness of the anterior table of bone over the frontal sinus. Whether the thickness of the bone over the frontal sinus will permit a 4mm reduction can only be determined before surgery by an x-ray. This is a pertinent issue over the inner half and central brow bone areas where the frontal sinus exists. It is not an issue over the outer half of the brow bones which are solid bone and without an underlying sinus cavity. 

Dr. Barry Eppley

Indianapolis, Indiana