Q: Dr. Eppley, I am interested in a custom forehead implant. My goal is to widen my forehead and make it look a bit more square. I also want some more central fullness. How do you decide to make these measurements on the implant in the design?
A: Of all custom facial implant designs, I find none ‘trickier’ or more difficult from an aesthetic standpoint than the male custom forehead implant. The design and having a satisfactory aesthetic result is much easier in females. What makes the male custom facial implant, and the male forehead implant, so aesthetically difficult is several factors. Anatomically, most men want a bit wider forehead and not a convex one like a female. This means that the anterior temporal line must be crossed in the implant design. If not, widening in this lateral forehead area may create an abnormal frontal bossing effect. The anterior temporal line is the bony boundary of the forehead. Crossing it to widen the forehead spills the implant over into the temporalis muscle/fascia area. While it is necessary to do this there is the judgment of where should the implant should end, how thick should it be, what shape in this transition should it have and there is a need to have a fine feather edge at the implant to soft tissue transition area to avoid a visible edge on the outside. These are all considerations in the implant design that women don’t have. Psychologically the risk of revisional surgery in all male custom facial implants is 25% to 33% and in the forehead this probably increases to 50% in my experience. This is always due to aesthetic issues of how the result finally looks no matter how much thought and effort was put into the initial custom implant design. It is also complicated in some male who have little patience for the time that it takes swelling to subside to see the actual final forehead shape.
Dr. Barry Eppley