Q: Dr. Eppley, I am a 36 year-old and I have a very thick and prominent brow ridge bone. A few years ago I suddenly lost my hair because of alopecia and now my forehead looks very unpleasant. I was wondering if you can offer bone reduction and reshaping solution for me. I have taken some photos of my facial profile which would be available if you required. I am serious to perform the procedure and at the same time have some concerns regarding the techniques to approach this procedure .
A: Brow bone reduction in a male, who is the most common type of patient who develops prominent brow bones, must always take into account the surgical approach. The only way to do brow bone reduction in any patient, male or female, is through a scalp incision. There is simply no other incisional method, even an endoscopic technique, that can provide the exposure for the instrumentation to do the procedure. In the male patient with no hair or a very sparse hair pattern the trade-off of a scalp scar must be considered very carefully. Essentially one is trading off one problem (prominent brow bones) for another. (scalp scar) This may be a reasonable trade-off but the magnitude of the brow bone protrusion has to be fairly significant and really deform the shape of the forehead to justify brow bone reduction in men.
Dr. Barry Eppley