Q: Dr. Eppley, I am interested in brow bone reshaping. I am wondering whether it is possible to make the inner corner of my brow ridge-glabellar more sloped. I would attach my photos in order to better address my requests to see if they are achievable. I am also attaching an example of the brow shape I am after as I think his brow ridge shape is very elegant. I found out that the formation of the triangular contour that I desire is formed by the downward slope of brow bone in the inner eye corner. Is it possible to, besides make the ridge-line more prominent, also make it more sloped?
Also, I had a previous glabellar implant (not fixed) which has an undesired shape and bad connectivity with my forehead and brow-ridge. I’m 100% sure that I’ll remove this graft sometimes (if not now, it has to be during my revision rhino), but I’m wondering whether it possible to remove this portion with the same incision of brow implant? I have consulted some doctors and they said the position of this graft is relatively high so it’s easier to remove this from upper incision instead of the incision of open rhino. How do you think?
A: When it comes to brow bone reshaping, the ability for remove bone along the medial supraorbital rim depends on two factors. First, the thickness of the rim bone in that area. you have to remember that the frontal sinus lies immediately beneath it. The bone is undoubtably a few millimeters thick so some change is possible, it is just a question of how much. Secondly, it requires good incisional access to reach down that low. No endoscopic or other more limited incisional technique will work.
Wherever the glabellar implant is located, it most certainly can not be removed through an open rhinoplasty incision. It must come out the way it was put in.
Dr. Barry Eppley
Q: Dr. Eppley, I have some questions about the lateral commissuroplasty procedure. Could a corner lip lift be done in a manner which would not shorten the upper lip or “plumpen” the lips (these things are mentioned as coming along with a corner lip lift but I would rather not have them as I think they would be top feminine). I also realized you do brow shaping. My eyebrows arch out on the ends and I would rather them lay straight across (or at least close to that). Could this be done? Finally, could all these procedures be done in one session?
A: You appear to have some misconceptions about the corner of the mouth lift. It does not affect lip size or shorten lip length. Whether a corner of the mouth procedure is done to lift up the corner or to widen horizontal lip length, there is no change in the rest of the lip shape or size.
From a brow bone shape standpoint, it sounds by your description that you have too much lateral brow bone protrusion. That can easily be reduced through an upper eyelid incision by burring down the side of the brow area that does not have the frontal sinus lying underneath it.
Both the corner of the mouth and brow bone procedures could be done at the same time. Combined it would be a two hour procedure done on an outpatient basis.
Dr. Barry Eppley
Q: Hi Dr. Eppley, I was wondering whether trauma to the brow bone early in life could have caused it to grow differently than it should have. I was on a trampoline as a child and fell onto the left side of my face and had large swelling there for about a week before it went away. Now that I am older I have noticed that the side of my brow seems to be lower, giving my left eye a perpetual sad look that I do not like. While I could be mistaken, and it could be scar tissue causing this asymmetry, I am wondering if this is due more to bone. If so, is there a cosmetic procedure to fix this and if the childhood trauma could have been the cause. Thank you.
A: Most certainly trauma to the brow bones can be a source of brow asymmetry. The trauma could have caused an actual deformation of the bone by infracturing the thin bone over the frontal sinus in an adult or causing a compression fracture in children that changes how the shape of the bone grows and expands. Such asymmetry is the result of the edge of the brow bone being lower than the unaffected side. This can usually be corrected by a brow bone reshaping procedure by shaving ‘up’ the lowered edge of the brow bone. This can be done through an upper eyelid incision. It usually takes about two to three weeks until all the swelling and bruising is gone.
Dr. Barry Eppley
Q: Dr. Eppley, I have uneven eye sockets, my right eye is higher than the left, just at the top, making it so my eyebrow is up higher on that side. I was wondering if there is any way to fix this? And what would have to be done if so? I would just like for my brow on that side to be moved down and out just a tiny bit.
A: Brow bone asymmetry may be caused by differences in the position of the entire orbital box, but more commonly it is just differences in the brow bones themselves. The shape of the brow prominences or the underlying shape or pneumatization of the frontal sinuses may just be different. In a female, it is the actual brow bone shape or arch. This can be treated by brow bone reshaping by burring which can be done through an upper eyelid incision, provided that only the outer 2/3s of the brow bone needs to be changed. If the entire brow bone needs to be altered, then the best approach is through a scalp or coronal flap with turn down with complete brow bone access and preservation of the supraorbital and supratrochlear nerves. If the outer tail of the brow bone needs to be built up, this is best done by adding a small amount of hydroxyapatite cement. The combination of select burring and augmentation can change the shape or arch of the brow to a lower level with a more symmetric tail.
Dr. Barry Eppley
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.
Q: I am really curious about brow bone shaping. I am wondering if it is possible to lower the brow bone. My concern is that the distance between my eyes and brow bone is very large and therefore my mid face looks very long. I want to shorten this and I think one of the most effective ways would be to lower the brow bone. Is this possible? How is it done, etc?
A: The brow bone is traditionally reshaped because it is too prominent. The so-called Neanderthal look occurs due to excessive growth of the frontal sinus which causes the outer table of the brow bone to stick out. This can be reduced by setting back this outer table of brow bone.
The brow bone can also be built up by various materials should it be underdeveloped or deformed from a traumatic injury.
Lowering the brow bone is a very unusual request as the need to do it is very rare. But the lower edge of the brow bone, however, can be brought lower. This is not done by moving the bone though. The lower edge of the brow bone can be built up with an implant material that is secured to the bone with very tiny screws. The implant is custom-carved during surgery to make an exact as fit as possible. This would be done through an upper eyelid (blepharoplasty) incision. Whether this would actually make the eyebrows look lower or create the effect that one wants is uncertain.
Besides considering a build-up of the lower brow bone, there are other considerations such as dermal-fat grafting to the upper eyelid sulcus which may create the same desired effect. I would have to see photos to make a more educated opinion on what is possible.
Dr. Barry Eppley