How Can My Profile Be Improved By Forehead And Nose Augmentation?

Q: Dr. Eppley, I am looking for a nicer more natural-looking side profile. I saw a before and after picture of a hispanic lady you did and like the result. I’m considering the following surgeries – brow bone augmentation, forehead augmentation and nasal bridge augmentation (higher nose bridge) to go with the newly adjusted brow bone.

I have a few questions…

1) Have you done this procedure on Asians before? If yes, mind sending me some before and after pictures?

2) How often do you do brow bone surgeries? I’ve done some research online and it seem that you’re the only surgeon that specializes in this.

3) How much are the costs to have the above surgeries?

4) What are some of the side effects/worst case scenarios?

5) Would you say I have protrusive eyes? I feel like there’s still some fat/excessive skin after eyelid surgery and my brows are too close to my eyelid.

Would also like to hear your recommendations.

A: In answer to your questions:

1)      Augmenting the forehead and nose to improve the profile is most commonly done in the Asian patient in my experience. They make up nearly half of all forehead augmentation patients in my practice. Building up the forehead with PMMA is the typical approach due to the volume of material needed. The end goal is to have a rounder forehead that eliminates any backward slope and flat profile to it. While the material can extend down and build up the brow bones as well, it is not possible to extend the material onto the radix of the nose to build it up as well. It may reach the frontonasal junction but true radix augmentation must be done from below as that area is part of the nasal dorsum not the forehead.

2)      Brow bone and forehead augmentations are done by few plastic surgeons and those who do them almost universally have a craniofacial training/experience background as that is how you learn to do any type of skull reshaping surgery.

3)      I will have my assistant pass along the costs of forehead augmentation to you by separate e-mail tomorrow.

4)      The most common side effects are shape or contour issues. How smooth is the result? Are the edges over the temporal lines visible? Is the amount of augmentation enough? Contour irregularities are the main reason for any revisional surgery which has a risk of about 10% in my experience.

5)      In looking at your pictures, I assume you recently had ‘double eyelid’ surgery based on the scar location. I will also assume that they didn’t take ouy any upper eyelid fat which commonly needs to be done in the Asian eyelid. Also, brow bone augmentation may increase the distance between the brows and the upper eyelid lashline.

6)      Lastly, radix augmentation needs to be done through the nose and is often part of an overall dorsal augmentation in an Asian rhinoplasty. I know that you stated you recently had a rhinoplasty but I do not know what was done. Did they build up the dorsum and, if so, with what?

I have attached some imaging predictions based on brow/forehead augmentation and a nasal dorsal augmentation.

Dr. Barry Eppley