Your Questions
Your Questions
Q: Dr. Eppley, I am 24 years old and my brow bone gets getting bigger. Is there something I can do to stop it expanding? Why is it doing it? Can an incision be made on both eyebrows to perform procedure? What would be your best idea without doing a coronal incision? Can a cut be made in my eyebrow so you can burr it down. ( wouldn’t be much) Then somehow either inject a filler into the top part of my forehead to smooth out… what about some kind of implant for the top part of the forehead? Does that need a coronal incision to be placed in?
A: At your age, your frontal sinus development is complete and should no longer be expanding. That is a function of skull growth which is long over now.
An incision can be made along the eyebrows known as the ‘Open Sky’ approach. It runs along the upper eyebrows and crosses over the nose. While it can be done, it is an historic approach that has largely been replaced by the coronal incision. I am not so sure that wouldn’t be more obvious than the coronal incision quite frankly but I wouldn’t yet rule it completely out
The key question about incisional approaches is what exactly needs to be done to the brow ridge to reduce it. In the vast majority of cases it requires infracturing or an osteotomy of the outer plate of the frontal sinus bone. This can only be done through a coronal approach. Usually simple burring is inadequate BUT if one has just a few millimeters of bone that need to be taken down and the area above it is built up with cement, the eyebrow approach may be reasonable. That could be determined beforehand by one simple x-ray known as a lateral skull or frontal sinus film. That would tell us precisely how thick the frontal sinus bone is and how much can be reduced by simple burring.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have an weird forehead. It has that I mainly have a brow as a man and it also has horns (exotosis) I was wondering if you do such surgery to fix this/shave down my skull to get me a desired smooth forehead as a female should have. I also have a high hairline so I’m wondering if you can pull it down. How old do you have to be? I know 18+ but the skull doesn’t finish developing until what age? I am 20 so I don’t know if I am old enough yet. Also, can both surgeries be performed at the same time?
A: The skull is largely finished developing by one’s early teens, it is the facial bones below it that continue to develop until the late teens with the mandible finishing complete growth around age 21. Therefore, at age 20 you can have frontal/brow bone reduction without any concerns about growth implications. The only issue is how much the brow bones can be reduced given the frontal sinus which lies underneath it. That could be determined before surgery by a simple lateral skull film. The hairline advancement/vertical forehead skin reduction is done through a pretrichial incision. This also provides the exposure needed for the forehead and brow reduction so, by necessity, these two procedures would be performed at the same time.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hello, I’m a 19 year old male. I recently cut my hair short and to my surprise, I have a very Neanderthal-esque brow ridge. It doesn’t stick out as far as some people from pictures I’ve seen, just a couple of millimeters probably. I was wondering if there was any alternatives to plastic surgery for this? Can small amounts of pressure be applied to the area over an amount of time to reduce the appearance, or anything similar? Obviously at such a young age I don’t want to resort to plastic surgery, but I dislike the appearance that my brow ridge gives my face. Thanks in advance.
A: The pneumatization or expansion of the frontal sinus cavity creates the prominence of the brow bones. This is not bone growth but bone stretching due to underlying air expansion. This is why the brow bones, the bigger they are, are very thin often only being a few millimeters in thickness. The development of a brow bone prominence or bossing is genetic and can not be modified once established by any external pressure or molding. If it is too aesthetically excessive, it requires surgery for brow bone reduction.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley,I am female, 35, interested in brow bone shaving. My brow bone is a bit too thick, and I feel it looks a bit masculine. Is there any risks to shaving the bone in the glabella area? Would this make the bone there too thin and easier to fracture in the event of an injury? I don’t need too much shaved, but wondering if even a bit of shaving is risky. Thank you.
A: The issue with brow bone shaving is not one of real medical risk. The only issues with brow bone reduction are two-fold. First, you need a scalp incision and turn down flap to do it. So there will be a resultant fine line scar in the scalp. Secondly, and more relevant to your question, shaving the brow bone has the risk of burring right into the frontal sinus cavity. Most of the brow prominence is not composed by bone at all, but by air from the sinus cavity undermeath. How significantly one can burr down the brow bone depends on how thick the outer cortical table of the frontal sinus is. Often times it is no thicker than 2 to 3mms. The glabellar area, the part of the brow bone between the eyebrows, often will have no frontal sinus cavity underneath so it may be able to be reduced much more.
For these reasons, it is necessary to determine a patient’s eligibility for brow bone reduction knowing in advance the location of the frontal sinuses and measuring the thickness of the bone. This can be done with simple plain x-rays taken from the front and side views. For some patients, brow bone reduction by burring is adequate (minority of patients), but other patients need to have done an osteoplastic bone flap technique due to their thin outer bone covering of the sinus.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 33 year old male who has a very prominent brow which over hangs my eyes by at least a cm especially from the bridge of the nose to brow. This severely affects my looks. I have already had surgery where the surgeon shaved the area down after peeling the skin over my face which did slightly improve my appearance but nowhere near enough. The only answer I can see as someone obviously without any knowledge of a medical procedure to facilitate this is that if the brow bone was trimmed from the sides and the brow and presumably nose ‘pulled back’ and recessed. After googling cosmetic surgeons you appear to be one of the few doctors that may be able to help me with this. I don’t consider myself a vain person but just wish to have a relatively normal life. Do you think my brow bones can be further reduced? If so what potential risks are involved. As a cosmetic surgeon I am sure you are more than aware of the psychological damage that looking unusual can be and I am placing hope that maybe this can be changed. Thank you in advance.
A: Brow bone reduction by shaving rarely produces a satisfactory result. It may be a simpler procedure but it can only reduce the brow prominence by a few millimeters. Any further reduction will enter the frontal sinus cavity. Men in particular require an osteotomy technique for brow bone reduction as the amount of reduction can easily be 5mm to 7mms, if not more.
Please send me a few pictures of your forehead for my assessment. You have already been exposed to the greatest risk of the procedure, that of a scalp scar
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, What is the cost of the brow bone procedure on average and what would the consequences of this procedure be if they were to occur?
A: While brow bone reduction can be a very effective forehead reshaping procedure, the two most important issues for any patient to consider are cost (average total cost $ 8500), of course, but also that a scalp incision will be needed to do the procedure. For many men based on their hair style and density, such a scar may be a disadvantageous aesthetic trade-off. While there are many other minor considerations to be aware of from this procedure, these are the first two hurdles to get over before one can ponder the less significant issues of brow bone forehead reshaping.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 27 year old man and I’m thinking to have a surgery to reduce the size of my brow bone. My question is if the look of my eyes would change. Because I have read in other forums that such surgery might change the deep of my eyes of which I love their appearance. I would appreciate very much your esteemed opinion to my concern. Is it justified or not? Thank you very much.
A: It has not been my experience that the depth of one’s eyes appears any different after brow bone reduction surgery. This is because brow bone reduction in men, in particular, is about changing the bulge or convexity of the anterior table bone of the frontal sinus. It does not change very much the lowest edge of the brow bone or reduce it posteriorly which would make the eyes look less deep. I would have to see some pictures of you, particularly from the side view, to make that determination more specifically however.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in forehead contouring surgery. My forehead is kind of rounded and I would like to have it more like square-shaped. When looking at a profile view my forehead sticks out where my brows are and my eyes look deep in the face. I also have attached a picture of a gentleman that his forehead looks more like square and that is exactly what I’m looking for or something close that will reduce my forehead. Thank You
A: Thank you for sending your pictures. Your forehead shape is a combination of brow bone protrusion and an upper forehead that slopes backward. Together this gives your forehead a 50 to 55 degree backward slant in a profile view. The desired forehead shape that you have shown is almost completely vertical. While that is not completely possible from the forehead shape that you have now, you can make significant improvement in your current shape. To change the slant of your forehead, you need to address the two components of the problem, brow bone protrusion and upper forehead retrusion. This is done through a combination of brow bone protrusion and forehead augmentation above the brow bone area. Neither brow bone reduction or forehead augmentation alone will make this improved shape. It takes this combination ‘ying and yang’ approach to create the substabtial forehead shape change that you desire. I have attached an imaged result of what I can think can be achieved by this approach. This would be done through an open coronal incisional approach.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I need a sinus setback procedure. I think it is called the brow bone. but my brow bone is a bit asymmetric. Will a browlift be needed after this surgery? Is in the quoted price also the hospital care and everything? How many days should I stay in your town all together? Also is it possible to make some sort of insurance arrangement in case something goes wrong so that I am fully covered in this case? Finally have you not seen or have you also not heard of anybone resorption with this procedure? Long term consequences really scare the XXX out of me.
A: In answer to your questions:
1) Generally, a browlift is not needed after a brow bone reduction. It does not usually cause the brow bone to fall.
2) Any price estimates given to you is all-inclusive of the surgeon’s fee, OR and anesthesia costs. A formal price quote can be given based on reviewing pictures of the patient. Most patients return home 48 to 72 hours after the procedure.
3) I can not think of anything that could go wrong with this type of surgery that would require hospitalizations. But most insurances will cover medical problems, regardless of the origin of the problem.
4) I have not seen or heard of any bone resorption afterwards with this operation.When properly done with good surgical technique, brow bone reduction should not result in any long-term bone resorption problems.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in facial reshaping. I’d like to get a more feminine face. I would like to reshape my heavy jawline and brow, correct the weak chin, do liposuction under chin and I would also like to correct any small asymmetries that would improve the appearance of my face. I have attached a front and side for your assessment of what can be done.
A: Thank you for sending your pictures. In looking at our face what is most striking are two things. First, you have a very strong facial structure as seen in your prominent brow bones and cheekbones. This upper part of your craniofacial skeleton is also broad as reflected in the wide base of your nose and its wide tip. Secondly, and in contrast, your lower jaw (mandible) is actually short both in the horizontal and vertical dimensions. This gives you the impression that your jawline is heavy, when in fact, it is really short which makes it wider than it is tall.
I have done some computer imaging projections based on what I think would make the most significant changes towards a more feminine face. These include brow bone reduction, rhinoplasty and chin augmentation. (both horizontally and vertically) One of the key components of this approach is that your lower face (jaw) needs to be vertically lengthened to change the shape of your face from square to more of an angular or triangular shape. Combined with reduction of the brows and thinning of the nose, your face will become softer and more feminine.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I am interested in doing a ” Brow ridge reduction “, at least that is what I think it is. Also I would like a chin reduction. So my questions are; Are these types of surgeriess even possible? How far in advance do I have to schedule them? Have you ever done similar work to this? I have attached some pictures for you to see what I mean. Sorry as they are not the best quality.
A: Thank you for sending your pictures. Your requests for brow bone and chin reduction surgery is not uncommon and these are established procedures. I am very familiar with doing them and get requests for them all the time. Brow bone reduction (technically frontal sinus reduction since the brow bones are largely sinus cavities not solid bone) is done through a scalp incision. The outer table of the frontal sinus is removed and set back which makes the brow bone less prominent. It is a very effective surgery and the only significant issue in men (which are by far those who request the procedure) is the need for a scalp incision and the resultant fine line scar in the scalp to access the forehead and brow areas. Chin reduction surgery is done different ways based on which dimension of the chin one wants to shorten. If it is a vertical chin shortening that is done by an intraoral osteotomy and bony wedge resection. If both a horizontal and a vertical chin reduction is needed that is usually done by a submental (under the chin) incisional approach and the bone is burred down and the soft tissues shortened and tightened to the smaller bone.
This will give you a general overview of your requests. Both surgeries are possible and are part of cosmetic craniofacial reshaping surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I need to have my brow bones/forehead contoured by you. I must let you know that I have had my brow bone shaved down 3 years ago and I have been having problems with air leakage into my forehead. I am thinking that maybe the dr. shaved down the bone a little too much. My forehead has a “flat” surface above my nose. I would like to have my forehead rounded out and possible have my eyebrow bone made a little bigger? Do you think that would fix or help the air leakage problem?
A: Brow bone reduction is about taking down the outer table of the frontal sinus. That bone is actually very thin and is not a solid block of bone as many people think. The brow bone can be reduced by burring or actually an osteotomy with plate fixation. It sounds like you had the brow bones reduced and have an area where the bone is too thin. This can happen in burring reduction by removing too much bone or in an osteotomy with plate fixation where there is an uncovered hole area. Either way, it is clear that you have a frontal sinus fistula as a result of a hole acting as a source for an air leak. This air leak should be pushing outward into the forehead tissues as it escapes from the frontal sinus which connects to the air cavities of the nose. You would do well with an hydroxyapatite cement brow bone augmentation which would build your brow out and close off the air leak as well.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I have very prominent brow bones and want to get them reduced. What would cause the frontal sinus space to become so prominent? I have an older brother who has a nice flat brow bone and forehead. Conversely, my father has somewhat of a prominent brow but not quite as large as mine So could it be just genetics? Or could it be from falling on my forehead when I was younger? As far as brow bone reduction surgery goes, I have read that it involves a scar across the top of my head. Given my hairline this is not very appealing. Is there a way of going between the very top bridge area of the nose and bottom of the brow to contour it that way and bypass the hairline all together?
A: There is no known reason that the frontal sinus expands to such a large degree, short of the presence of a sinus tumor. It has nothing to do with trauma and is just purely a genetic blueprint issue.
There is an alternative to a scalp or coronal incision which is done directly as you have indicated. It is an incision done directly across the brow bone area, being just at the brow hairline margin and then coming across the middle by stepping done into a horizontal skin crease between the top of the nose and the forehead area. This is known as the ‘open sky’ approach and has an historic use for the treatment of fronal sinus fractures and tumors. For most men, it is a better option for brow bone reduction than a scalp incision and would be less noticeable. It would also make the surgery less traumatic and involve a quicker recovery. It does heal as a very fine line scar. If one’s brow is big enough and disconcerting enough, this is a reasonable approach.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Hello Dr. Eppley I am a 28 year old male with an extreme prominent brow ridge. I have been doing research on this and understand the male vs female forehead anatomy. It seems my brow is quite larger than a typical caucasian male and was wondering if I went through a surgery for this what would be the result. I’m certainly not looking to become “feminine” by any means. I am a heterosexual male, but the size of my brow makes me feel uncomfortable and self-concious. I have a cephlometric x-ray of my profile view so you can see the size of the brow and maybe show me how much of a change is possible. Thanks for taking the time to read this, it’s a great website you have which is very informative.
A: Thank you for sending your ceph x-ray. There is no question that you have a very large pneumatized frontal sinus air space which is the cause of the prominent brow bones. The size of those brow bones are very good candidates for significant reduction through a brow bone reduction osteotomy technique. This is done by removing the outer table of frontal sinus bone, reshaping it, and then putting it back in a much flatter shape and secured with tiny titanium plates and screws. I have attached the ceph x-ray computer imaged as to how much flatter it can be.
The biggest issue for a male brow bone reduction is the scalp incision/scar required to do it. That often is the rate-limiting step for most men and is highly influenced by the man’s hair density and hairline pattern.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Hello Dr Eppley. I am now 23 years old and up until the age of 18 I had a flat brow bone. Now it bulges out unevenly and hangs over my eyes. I look completely different now. It may have happened after I scrubbed my brows with a scourer to remove hair dye 5 years ago. It really is since then that it has happened. My brow bone was not meant to be like this, I look quite wierd now. My eyes were allways my best feature. I dont understand how this happened apart from the metal scourer incident. I really need some advice on how to rectify the problem if possible. I also have problems with my sinuses that may have something to do with it. Thank you for your time, I hope you can help.
A: This is not the first time that a patient has contacted me about having ‘brow bone growth’ in their early adult years. It is certainly possible that the brow bones can grow beyond the teenage years, although technically it is the growth or ongoing pneumatization of the underlying frontal sinuses. All I can say for sure is that the metal scourer event is not the cause. It is not possible to stimulate craniofacial bone growth by stimulating the overlying skin. It may or may not have sonmething to do with sinusitis or it could even be a sinus tumor. I would recommend getting a CT scan of the frontal sinuses/forehead to determine if this is just an overexpansion of the frontal sinus space or whether there may be an underlying sinus tumor. If it is just growth of the frontal sinus, then brow bone reduction can be considered.
Dr. Barry Eppley
Indianapolis Indiana
Q: I am interested in brow bone reduction surgery, flattening my prominent brows. I’m bald and was wondering if the incisions could be done via eye bows as I have no hairline. I was wondering a little about pricing and if there are payment options. Are there any tricks to have your health insurance assist paying for the procedure? Thanks.
A: Unfortunately, you are not a candidate for brow bone reduction surgery. You can not use your eyebrows for the incisions as this would cause unacceptable scarring, particularly across the bridge of the nose. This would also cause permanent loss of feeling of your forehead up to your scalp. The operation requires an approach from the scalp which is not possible given your lack of hair. In addition, there are not tricks for getting insurance to cover an operation that has no medical basis or symptoms.
Indianapolis Indiana
Q: I am very self conscious about my forehead. I have a strong square jaw and a square forehead as well. I like it that way but my forehead has two bumps on either side (genes) below my hair line and I have two bumps (kind of an eyebrow ridge) over the beginning of the eyebrow above my nose. Can these two bumps near my hairline be chiseled as well as the eyebrow ridge? You can especially see the unevenness under a light directly on top and overall it makes me look way too rough or mean.
A: Forehead irregularities and prominences can be either those that exist in the brow area (prominent brows) near the eyes or those that exist above the brows up to the hairline. They represent different types of bone problems and are treated differently. Forehead bumps are simple raised areas of excess bone that can be simply burred down. Prominent brows, however, are not bone thickenings but are expanded frontal sinuses. They may appear as prominent thick bone but it is largely air with very thin bone. They are treated through an osteotomy approach with bone reshaping and recontouring.
While both of these forehead type surgeries can be done, the rate-limiting step as to whether they should be done by the patient is the need for access to do the surgery. This requires some type of scalp incision. Whether this trade-off of a scar is worth it to the patient must be decided on an individual basis.
Indianapolis Indiana
Q: Dear Dr. Eppley, I wonder whether you could give me some advice about forehead recontouring. I have a very prominent brow and two bony protusions on my forehead. I look fine straight on but at 45 degrees I look extremely hollow-cheeked and my eyes look abnormally deep-set. I tried cheek implants about 15 years ago (they have since reabsorbed) but of course these only made my eyes look even deeper-set. I also have a very strong chin and nose but can’t reduce these either because they go some way to balancing out my brow line. Would you be able to provide me with some idea as to my suitability for surgery? Thank you very much.
A: Occupying the upper one third of one’s face, the shape and size of the forehead can impact significantly one’s facial balance and appearance. Your description illustrates that quite clearly. The brow bone area, known medically as the supraorbital rims, is a bony prominence like the cheeks and chin in the lower two-thirds of the face that has cosmetic significance. When it is normal (not protruding) one does not give it a second thought. When the brow bones are excessive, however, it can change the look of one’s entire face…and changing other parts of the face will not really ‘hide’ the brow protrusion or its impact on how one’s eye area looks.
While the shape of the forehead and brows is significant, it is not commonly surgically changed. This is not because the possible forehead recontouring procedures are difficult, have high risks, or involve a long recovery, as they do not. It is because it requires an open approach with a scalp incision and a resultant scar in the scalp. For women this is not usually a major stumbling block, but for most men it is. Since many more men have forehead concerns than women, this makes the number of cosmetic forehead contouring procedures that are done fairly small.
Indianapolis Indiana
Q: I am a male and would be interested in receiving a surgery in order to correct my bulging forehead. Do you perform that kind on procedure on men?
A: Forehead surgery or forehead reshaping can mean different things to various patient, both male and female. The two most common procedures performed on the forehead are brow bone reduction in the male and brow bone reduction/tapering in the transgender patient. (male to female) There are also a variety of other forehead reshaping procedures from defects and asymmetry caused by craniofacial birth defects and trauma and prior neurosurgical/craniotomy operations. Bu, by far, regardless of the diagnosis the vast majority of forehead surgeries are done in men.
The typical cosmetic reason for male forehead surgery is brow bone reduction. Large brow bones, caused by overgrowth of the underlying frontal sinus, can create very prominent bulges in the forehead bone above the eye. (supraorbital rims) While most patients think it is a thickening of the bone and a simple burring down will suffice, this is not so. Rather the frontal table of the frontal sinus (visible brow bone) must be removed, reshaped, and then put back in a more flatter or recessed position. While tremendously effective, the access to perform that procedure requires a long scalp incision. This cosmetic trade-off is a serious one to consider and is usually an issue which prevents most men from having the procedure. Until a more minimally invasive approach to brow bone reduction is developed, most men with prominent brow bones will have to live with them.
Q: Dr. Eppley I heard people with protruding brows just have some of the forehead protrusion above the eyebrow cut or shaved off some. No metal plates and screws! Am I correct?
A: No you are not correct. Brow bone reduction requires that the outer table of the frontal sinus (the bulge or protrusion) be removed (cut off), reshaped, and then put back in place in a flatter shape. Putting it back in place requires small low-profile metal plates and screws to properly hold the reshaped bone in place until it heals.
The reason that the bulging brow bone can not simply be burred or shaved down is that this bone is actually very thin. The bulge is present, not because the bone has gotten thicker, but because the air-filled frontal sinus has expanded pushing out its front wall. For significant brow bone reduction to occur, the bone must be taken back as much as 8 to 10mms. The thickness of the frontal wall of the frontal sinus is only about 2 to 3mms thick. Burring into it would only expose a deep empty sinus cavity, not bone.
Bony protrusions or thickening above the brow bone, however, can be shaved or burred down as there is no underlying sinus cavities above the brow. Bone in most of the forehead can very safely be taken until one nears the diploic cavity or marrow space which could be 5 to 7mms of width reduction.
Indianapolis Indiana
Q : I am a male. I would like to know if Dr. Eppley can do orbital brow bone shaving and whether this can be done without coronal incision. My goal is to achieve a more feminine smooth forehead.
A: Brow bone reshaping can involve different areas of the brow depending upon what one’s aesthetic goal is. If one is interested in a total brow bone reduction, as one would want for a very prominent supraorbital ridge (brow bone), then a coronal incision is needed. This is because at the inner half of the eyebrow are the supraorbital and supratrochlear nerves which supply feeling to the forehead. They can only be pushed out of the way from above without injuring them. In addition, the inner half of the brows are not solid bone but just a thin bone covering over the air-filled frontal sinus. Total brow bone reduction can not be done by shaving but by taking the outer bone off, reshaping it, and putting it back in place.
The outer half of the brow, however, can be surgically altered by both shaving and without needing a large coronal incision from above. This is because the outer half of the brow is solid bone and away from the frontal sinus. It can be done through an upper eyelid incision. The tail of the brow can be reduced and tapered to create more of a lateral sweep which is associated with more of a feminine look.
Indianapolis, Indiana
Q: Hi. i am an 18 year old male who is looking at getting something done to flatten my forehead and reduce my brow ridge, as I am unhappy with how it looks. i just wanted to know if I am a bit young to be getting something like this done? Also I play a fair bit of soccer so would like to know if it would affect how I header the ball permanently if I was to get surgery like this? Also would the scarring be noticable if it were not on the hairline?
A: From your description, it appears that one side of your forehead is more protrusive than the other, giving you forehead and brow asymmetry. The surgical technique for brow reduction is more effective than forehead reduction. The middle and tail of the brow bone (which is usually the most noticeable) can be burred down fairly significantly. The forehead bone that extends above it, however, can not be so significantly reduced. The outer table of the forehead bone (cranium) is only about 5mms or so thick before the diploic space is entered. From a practical standpoint, you don’t want to be reducing the bone into the diploic space so only about 4mms or so of bone can be reduced. While this would make some difference, the brow reduction and shaping would be more significant. The other important issue is that to do the forehead reduction, a large coronal scalp incision would be needed. This creates it own aesthetic issues and the trade-off of the scar for the amount of forehead reduction may not be a good one.
Doing the brow bone reduction, however, can be done through an upper eyelid incision. Given this hidden scar and for the amount of brow improvement, this would be a much better trade-off.
Indianapolis, Indiana
Q: I have a few questions that I have been wondering about for a long time. First, what causes frontal brow bone growth? The reason I am asking is because since I turned 21 it seems that my frontal brow bones have grown outward. When I look at the side of my face, there is not that smooth appearance that there once was when I was a teenager and this is because of my frontal brow bones poking out. I have always been considered a good looking guy but since this has started happening, I have gotten to be very self conscious of my looks.
One more question…. and this may seem like a very odd question. Does sleep deprivation or a very weird sleeping pattern have any thing to do with frontal brow bone growth? The reason I am asking this is because just before I turned 21, I developed a sleeping disorder. Not long after this sleeping disorder started, it seems like I started noticing my frontal brow bones getting a little bigger. I am 24 today and I still have a sleeping disorder. I have helped it quit a bit by taking medications to help with sleep. Anyway, my brow bones are bigger than I think they should be and I am just wondering if sleep deprivation has anything to do with frontal brow bone growth.
I have really want to know the answers to these questions for a long time and it would be greatly appreciated if you could please answer them for me. Thank you.
A: The development of the frontal sinuses does not begin until after age 6 and often will nolt be evident on an x-ray until age 9 or 10. The frontal sinuses are air-filled cavities that drain into the nose. Their growth should be consistent with that of the skull which is usually complete no later than age 18. Prominent brow bone often do not become apparent until after puberty for many young males and they seemingly ‘grow’ up until the late teenage years.
Sleep deprivation or any form of sleeping disorder is not a known case for the development of prominent brow bones.
Prominent brow bones can be reduced through skull reshaping surgery. I perform this by taking off the frontal later of bone over the sinuses, reshaping the forehead, and putting it back on. While very effective, a male must consider the trade-off of a fine scar in the hairline which is needed to gain access to the bone to do the procedure.
Indianapolis, Indiana
Q: Hello, I am a 28-year old male with very prominent brow bones and I would like to have them reduced to a normal size and shape. What is involved in doing this kind of plastic surgery? Are there any significant risks and do you think the results will be worth it? Thank you very much and I look forward to your reply.
A: Brow bone reduction is more than just burring down thick brow bone ridges. It actually involves removes the outer plate of the frontal sinus, reshaping it, and putting it back on. A prominent brow bone is really not bone, it is an overgrowth of the frontal sinus. Brow bone reduction is really about reducing the size of the air space of the frontal sinus, in essence making a room smaller by lower ing the height of the roof.
Brow bone reduction must be done through a scalp incision. While the operation is not complex or dangerous for those trained in craniofacial plastic surgery, it requires that expertise and training to be very comfortable doing it. The key aspect in the decision to have the operation, in my opinion, is the acceptance of a scalp scar. One should have a good density of scalp hair and some confidence that all hair on the top of the scalp may not be eventually lost.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Hello, I wonder if you can help my son (19 year of age) who suffers from low self esteem due to the appearance of his head size since he started school. He has seen four psychologists and therapists to help him deal with his concerns. The problem is his head size which is too big. I know that nothing can be done to reduce the overall size of his skull but he also has very prominent brow bones which draws attention to his face making him more self conscious. Can anything be done about this?
A: Skull shape and size is one of the features of our appearance that we take for granted…unless it is too big or small and out proportion to the rest of the face. When the skull is bigger, a form of cosmetic macrocephaly, the sheer thickness and surface area of the bone make any reduction not practical to surgically consider.
It is not surprising that another part of the skull (brow bones) is big given the overall size of the skull. Changing something on the face that is likewise bigger and out of proportion as an alternative is a form of ‘camouflage’ and can be psychologically empowering. When faced with a physical problem that is unchangeable, being able to positively modify something else can be a good diversion that can provide some self-image enhancement.
Prominent brow bones are the result of overgrowth or pneumatization of the frontal sinus. Reducing them involves takes off the front table of bone, which is quite thin, and putting it back in a reshaped and flatter form. That can soften the forehead and orbital appearance which is where most eye contact in conversation is directed.
Dr. Barry Eppley
Q : I would like my brow bones reduced. I am now 20 and until about 12 years old my brow areas looked normal as best as I can remember. Since then they have continued to grow, or at least seemed to, to the point that I look like a Cro-Magnon man. My parents took me to get evaluated by an endocrinologist around age 14 or 15 to see if there was some reason and to make sure I did not have acromegaly or some other hormone problem. Those tests were normal. I feel like a freak with the way I look. How is this surgery done?
A: Prominent brows are not due to excessive bone growth of the forehead per se. Rather it is due to the overdevelopment or pneumatization of the frontal sinuses. The frontal sinus is an air-filled space between the inner and outer bone surfaces of the forehead brow bone. They empty into the lower portion of the nose through long ducts. Sometimes they exist as two separate cavities above each brow. Other times, they connect across the middle and are just one big frontal sinus.
The frontal sinuses do not even begin to develop until age 8 or older. They do not stop forming until well after puberty. When the airspace gets too big, it causes the bone on the outer side of the sinus to bulge out. Why some people’s brows remain flat and others ’overdevelop’ is not known. While there can be a medical reason, such as a pituitary tumor, most cases are idiopathic. (they just happen for no apparent reason)
Brow bone reduction surgery involves taking off the bulging outer plate of bone and reshaping it. During the operation, the cavity of the frontal sinus is widely exposed and the reshaped outer plate of bone is put back with tiny plates and screws. While this sounds like a gruesome operation, it is not. In many ways, it is a glorified brow lift using the same scalp incisional approach. It is the same operation as a frontal sinus fracture repair.
The sticky issue for men is the need to create a fine line scalp scar behind the frontal hairline. Based on hairlines and density, this may be a concern for some men.
Dr. Barry Eppley