Q: Dr. Eppley, is there a way to reduce my forehead size or flatten my forehead? I have some substainal bumps from being tripped when I was 11 years old and they haven’t ever reduced or went down in size. The bumps are not too large on the front part of my forehead. Is that possible?
A: Bony forehead reduction can be done to some degree based on the size of the bone bumps and the thickness of the outer table of the frontal bone. Raised bumps can easily be reduced down to the level of the surrounding forehead. Beyond that about 4 to 5mms of forehead bone can generally be reduced before the diploic space between the outer and inner cranial tables is breached. Depending upon the exact nature of your forehead irregularities it can be very effective or at least offer some contour improvement. Burring reduction of the forehead area can be done through a pretrichial or hairline incision.
Dr. Barry Eppley
Q: Dr. Eppley, I have a large bump on my forehead that has bothered me all my life. I am a 25 year-old man and this kind of gives me a ‘horned’ appearance. What are my options for getting rid of it? I have attached some pictures from different angles and it becomes really prominent when I raise my eyebrows and put wrinkles on my forehead.
A: Thank you for sending all your photos. The involved forehead area is quote distinct and, interestingly, does not allow any wrinkles to form across it. I suspect that is from the effect of pressure where the overlying forehead tissues are being pushed out more. The cause of this forehead ‘bump’ most likely is just a thicker area of forehead bone but I would always confirm that with a simple lateral skull x-ray before operating on it for burring reduction. This bump is moderately large so the issue is one of surgical access. I would definitely not make a hairline (pretrichial incision) because your hairline, like most males, does not appear stable for the long-term. The endoscopic approach could work but that also placed a sagittal (vertical) incision behind the hairline, that once again, may not prove stable. I think the best and most direct approach would be to use a horizontal forehead wrinkle line. This would also provide access to get the greatest amount of assured bony reduction which is obviously the intent of the operation. This form of frontal skull reshaping is actually very simple with minimal recovery, it is just all about how to get in to do it and where to ideally place an incision.
Dr. Barry Eppley