Q: Dr. Eppley, I am interested in forehead and brow bone implants augmentation. I’m an Asian male, living in Korea, whose appearance is just like any other Asian’s. My eyes are very big for an Asian’s, but they are pretty much bulging. Besides, the prominence of my forehead and brow bone (I have heard that it’s called ‘supraorbital ridge’ or ‘supraorbital torus’) is very slight. It makes my eyes looked more bulging. And it also makes the distance between my eye and eyebrow look too far. All these all things make me look feminine. It’s really awful. Many people tell me that my eyes looked ‘faggy’.
So I’m considering the forehead and brow bone augmentation with intraoperatively applied bone cement. As you know, preformed custom implants easily makes
empty space between itself and forehead bone, and it can cause fatal side effects like dropsy. So I think bone cement will be better, but I want to know what
you think. I have wondered about this. For years, I have searched for a hospital who does forehead “including brow bone” augmentation surgery, but all hospitals in Korea told me it’s dangerous to use any implants on the brow bone, because there are much important nerve on brow bone region. So I had almost given up, and just at that time, I found your
website in google. So I wonder whether this surgery is really dangerous or not.
Finally, I wonder how much my forehead can be protrude by surgery. You know I am Asian, and I want to make my forehead and brow bone protrude as much as a Caucasian, if it’s possible. I really want to know whether it’s possible or not.
A: I have done forehead and brow bone augmentation over my career by every conceivable method including PMMA and hydroxyapatite bone cements, prefrormed Medpor implants and, more recently, custom forehead and brow bone implants.
Each of these methods have their own distinct advantages and disadvantages…neither one is perfect. Bone cements are very good to use but they require a lot of intraoperative shaping, can be very expensive (HA cements) and can lead to frontal bossing/protrusions if the forehead and brow bones is brought too far forward. (as bone cements should not extend beyond the anterior temporal lines onto the tenporalis muscle fascia where they will not adhere and can lead to visible edging). To place them well, they require a long coronal incision to get adequate exposure way down to the suprarbital ridge. They are also associated with modestly high revision rates particularly when the amount of augmentation needed/desired is significant.
Custom forehead and brow bone implants have numerous advantages over bone cements. Computer designing the implants allows much greater precision and control over the amount and symmetry of augmentation. They can be designed with forehead widening in mind in large augmentations as the material can sit without complications on top of the temporalis fascia beyond the anterior temporal lines. The potential open space under the implant (which I have never seen to be a true problem) can be circumvenyed by screw fixation and the placement of numerous perforation holes in the implant to allows for tissue ingrowth through the implant and down to the bone. A custom implant also allows for a smaller scalp incision to be used to place it since it already has the desired size and shape through preoperative designing.
There is no truth at all that forehead and brow implants are dangerous. They are no more ‘dangerous’ than bone cements. They do not cause ‘dropsy’. They do not have a greater incident or risk to the supraorbital nerves than bone cments.They require the same amount of tissue dissection down onto the brow bones that bone cements do. Forehead and brow bone implants are just as safe as bone cements, they just are another implant option to consider for aesthetic augmentation in this area that has its own unique advantages.
Dr. Barry Eppley