Q: Dr. Eppley, I’m a very active 28 year old man who has both a scar and bump at the top of my forehead. They have both bothered me for years. I have been meaning to contact your office for quite some time, but have been a little hesitant. I would like to learn more about my options. I guess we can discuss everything in more detail once we make contact. I tried to take the best pictures possible to make out my concerns. I took one with a ruler just to give you an ideas of the length of the scar, its about half an inch long. You can semi make out the bump I’m concerned about, the high point of it is around the location of the scar. I look forward to hearing from you.
A: Thank you for sending your pictures. I can see the forehead bump which I view as more prominent and obvious than the small scar. The scar can be used for incisional access to burr down the forehead bone bump. The real question is whether the concomitant revision done on the forehead scar would end up much better after it healed. This is because of two factors, your ethnicity with darker pigment (which notoriously scars poorly) and that there would be some stretching of the skin edges for the bone bone burring. (which could potentially cause the scar to hyperpigment or widen after healing)
Dr. Barry Eppley
Q: Dr. Eppley, I was wondering if you could help fix my forehead; it’s been through a lot. When I was a toddler, I ran face-first into a wall, and since then, I’ve had a bump on the right side of my forehead. A year ago, it started to seem more prominent, and it wasn’t my imagination, because family pointed it out too, and sometimes the bump felt sore. I went to see a dermatologist who referred me to a facial plastic surgeon who injected the bump with steroids. This only left a dent around the bump, which he filled with Juvaderm, which has since worn off. Now I have a dent and a bump, and they each make the other look more prominent. It’s mostly noticeable when I move my forehead, which is a lot, because I’m pretty facially expressive. What should I do? I’d be happy to send pictures. Thanks!
A: Please send me some pictures of your forehead issue for my assessment. With your history, that bump is bone and not scar. That is the typical reaction to forehead trauma, a subperiosteal bleed that is a stimulus for bone formation. I would not have expected steroids to do anything. Most likely this would require bone reduction for elimination. The dent issue is soft tissue atrophy from the steroids which may need to be filled out with a dermal graft ‘ring’ around the area of bone reduction to get the most even forehead contour.
Dr. Barry Eppley
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.
Q: I have two forehead bumps that are very distressing to me. They have been there since I was very young. They stick out like horns and I am very self-conscious of them. Can they be taken down and made smooth with the rest of my forehead? What is involved in this type of surgery and what are the risks?
A: Thank you for sending your pictures. I can clearly see the two upper forehead bumps. While they are not true osteomas, they are protrusions of the frontal bone. They can easily and simply be reduced through burring reduction. You can take down the outer table of the frontal bone in these areas up to 5mms to 7mms which should make them smooth and even with the rest of your forehead contour. This can be done through an incision either back in your hairline or just along your hairline. This would result in a very fine line scar. The hairline incision, commonly used in pretrichial or hairline browlifts, offers an advantage in that one could advance the frontal hairline forward if one desired. In your pictures, it appears that your forehead is fairly long between the hairline and the eyebrows. That distance could be easily reduced at the same time by bringing the hairline forward. I have found that to be very helpful with burring down upper forehead prominences as the combination of bone reduction and a shorter forehead length makes for a very smooth and more pleasing forehead shape.