Male Brow Bone Reduction

Q: Dr. Eppley,  I am a  male interested in brow bone reduction. i have actually seen five surgeons….I vaguely talked to a plastic surgeon about it while I was getting basal cell removed from my nose. You mentioned the incision and that great thought needs to be put into it being done in a male.  After talking to surgeons I am a little confused about the scar.  One surgeon suggested either one of two things, a cut around the whole top of my head or multiple smaller incisions called endoscopy. He told me the same thing that we need to really think about it but he was referring more to male pattern baldness which is unknown.  Then I went back years later and he told me he wouldn’t work on me.  Another surgeon said he’d make an incision so thin that I could be bald and it wouldn’t be noticeable. Another surgeon said the same thing but I believe he said he’d just make two incisions at the top of my forehead and kinda do an endoscopy type thing and pull up my brow…burr it down and remove calcium deposits.  He said the way they were going to do it was that my forehead would appear smaller because my hairline would come down which sounded good to me. I think when I was a baby and since my head is large…I know there was a problem with me crowning when I was born…I think since my head was soft like all babies are it affected the way my hair grows to… hair grows down not straight up… I can’t grow it very long at all…matter of fact I generally have it shaved on the sides at a 1 or 2 guard….I  am afraid that you would see the scar.  I am also aware that there are hair grafts and I am wondering if that could be useful in my case.  Make no mistake the biggest problem is my brow…..its just two low, kinda grows downwards, and just looks extremely heavy.  I only get one life and I really need this done. I don’t want to make a mistake and fix something, but look unnatural or have a scar I have to worry about.  I’m not looking for a miracle…..before I turned 16 my brow wasn’t developed like it is now but my head was still wide…..i just want a more normal, natural, attractive, and vibrant appearance.

Thank you so much.

A: Let me help clarify the thought process for you about the approach and the scar that would need to be used to adequately perform your male brow bone reductiono surgery. First the procedure. The only approach to brow reduction that is going to work for you is not just simple shaving, that simply will not be enough and will not create enough of a difference. So throw out any suggestions about an endoscopic or limited incisional approach through your scalp. Your brow bone reduction needs to be an osteoplastic brow bone setback technique. Nothing short of this going to work. Second the incision. A osteoplastic brow bone setback technique needs wide open surgical exposure to perform adequately. Your incisional choices are either a full coronal scalp incision from above (almost ear to ear) or a mid-forehead incision through the deepest horizontal skin wrinkle that you have. The surgeon who told that a full coronal scalp incision could heal so well that it would be invisible if you are bald…is flat out wrong. That is complete fantasy and misinformation. While they can heal well and look good with hair, the scars often get widest in the temporal area and would never be well hidden with thinning hair or if one is bald. Given your concerns about the scalp scar I do not consider this a good option for you. This leaves with the mid-forehead incision which I consider to be the safest aesthetic choice. You already have horizontal forehead wrinkles so a scar that would look like one of them is a wider choice.

Dr. Barry Eppley

Indianapolis, Indiana