How Much Brow Bone Reduction Can be Achieved By Burring?

Q: Dr. Eppley, I must correct myself in my language regarding frontal bossing reduction through deburring.  I’ve provided a number of pictures including two x-rays.  We have similar bone structure.  Hopefully, between these images you might have a better idea of how much frontal bossing you can remove by deburring.  As you said it may be enough to give me a more feminine profile by debossing using a small incision.  Can this procedure result in nerve damage or long term numbing of the area?  Would you be able to also debur the tail of the brow bone over the eyes to open them up more?  

Thank you for your information regarding the rhinoplasty & lip lift as one procedure.  To confirm if you did both together you would perform a closed rhinoplasty to eliminate/reduce scarring?

A:The determination of How much brow bone projection can be reduced, otherwise known as thinning of the outer table of the frontal sinus, is ultimately determined by a 2-D CT scan to make an accurate assessment. Any picture imaging done is an estimate based on experience of  how much likely could be achieved. The tail or outer aspect of the brow bone is not subject to the limitations of the medial brww bones as there is no frontal sinus in this part of the brow bone. While the medial brow bones may be able to be treated due a small scalp incision the outer tale of the brow bones cannot. Using such a limited approach it is better to do the tail of the brow bone reduction using an upper eyelid approach. You are in need of an upper blepharoplasty anyway due to the large amount hooding that you have. Reducing the tail of the brow bone alone is not going to open up your eyes given the large amount of U\upper eyelid skin that exists.

Any method of elevating the forehead tissues is going to result in some temporary numbness which is almost never permanent.

With the type of nasal changes that you need a closed rhinoplasty would be a poor surgical approach. You need an open rhinoplasty to optimize the amount of reduction and reshaping. The scarring from an open rhinoplasty is virtually nonexistent and I’ve never yet seen a scar revision requested from an open rhinoplasty. The concern about an open rhinoplasty in your case is the potential concomitant subnasal lip . There is a small strip of columellar skin that would exist between an open rhinoplasty and the subnasal lip lift incisions which has the rare risk of vascular compromise. As a result I am very cautious when considering combining these two procedures. In looking at your thin upper lip, which has limited vermilion height from corner to corner, the subnasal lip lift is not a good choice for lyour ip augmentation as you will essentially get a A frame deformity. (the center of the upper lip is elevated but the sides  of the lip is not) You would be better served with a vermilion advancement from corner to corner which can also very safely be done with an open rhinoplasty.

Dr. Barry Eppley

World-Renowned Plastic Surgeon