Your Questions

Q: Dr. Eppley, I would like to consult with you concerning forehead contouring. I am mostly interested in using an injectable filler to achieve a more vertical and convex shaped forehead.

A: Forehead contouring can be done by a variety of surgical and non-surgical methods. But their effects in achieving the desired forehead shape is not the same and those distinctions are very important to understand. The use of any form of injectable filler for forehead augmentation is not a good treatment method for forehead augmentation. Whether it is a temporary filler or fat material, the result will often be irregular and only temporary. While there is nothing wrong with injecting fat into the forehead any irregularities may or may not eventually resolve as the fat resorbs and heals. Using bone cements or an implant is far more reliable and produces a much better result. Getting the desired shape with a smooth contour requires a material that can consistently allow that to happen. And placing the material through a scalp incision is the best method from which to accomplish that goal. I would need to see pictures of your forehead to better answer what would type of forehead contouring procedure would work best for you.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley,I am interested in forehead contouring.  I have a hard lump at the centre of my forehead for the past eight years now. it is not really big but it is noticeable. Please i need a surgery for this because I have been experiencing a hard time with my life with this forehead lump. I have attached some pictures from different angles so you can see my forehead lump.

A: Thank you for sending your forehead pictures. I can clearly see your central forehead lump. There are two ways to do your forehead contouring to get rid of this central lump. First the forehead lump could merely be burred down to the contour of the surrounding forehead. The other approach would be to build up the area around around the lump so the entire central forehead area is smooth. (fill in the two grooves on each side of the lump) Which way is best depends on how one prefers the shape of their forehead to be. The other consideration is the surgical access to do either one. Both could be done through a small incision at the edge of the frontal hairline. (irregular pretrichial incision) to blend in at the edge of the hairline.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Do you have experience with facial feminization surgery? Particularly with forehead recontouring, rhinoplasty, adam’s apple shaving, and hair line lowering?

A: I have considerable experience with facial feminization surgery (FFS) procedures, particularly the four that you have mentioned which are some of the most common FFS operations. All can make very successful feminizing effects. The key to the hairline lowering is the density of the frontal hairline where the incision has to be made. If this is adequate then the hairline can usually be lowered in a single stage of up to 2 cms based on one’s natural scalp laxity. Combining forehead/brow bone contouring with hairline lowering is particularly convenient since the pretrichial incision provides direct access to the entire forehead. Adam’s apple reduction (aka tracheal shave) is the simplest of the procedure and how much is can be reduced is dependent on what incisional access is used. (directly over it or the more remote submental incision) Reshaping the nose through a rhinoplasty to create a smoother and less prominent nose result depends on the thickness of the overlying skin. The thicker the skin the less it will contract and the size of the nose will reduce less.

Please send me some pictures of your face for my assessment and computer imaging to see what changes may be possible for you.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in forehead reduction/hairline advancement surgery. I am a 20 year old female, and I wanted to ask about forehead recontouring. I would like to know more information. I am self-conscious about my forehead as it curves/bulges outwardly. I’m not sure if this is applicable to this, but I have included a picture to get a better opinion.  I also want my hairline lowered. Will a tissue expander be needed?

A: The success of frontal hairline advancement depends on the tightness of one’s scalp and how much forward movement of the hairline one desires. If the scalp has some looseness and the amount of hairline advancement in not greater than 10 to 15mms, then a scalp expander will not usually be needed. Although I have seen some patients whose scalp is so tight that is barely moves even with full release.

A hairline lowering will help but will not get rid of the bulge appearance completely. The two procedures are often done together for maximal effect.

Based on this profile picture you have sent, I think your rounder forehead can be made flatter. The relevant question is how much? Generally up to 4 or 5mms can be taken from the most central prominent area. But I alway check a simple skull x-ray first to see how thick the bone is in that area.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have been looking at your web site for over a week now and I believe I have finally found a perfect plastic surgeon for my problem with my forehead. I’m 58 years old in fairly good health. I’ve had car accident long time ago when I was about 20 years old, which left a scar running vertically in the middle of my forehead. It looks like a thick vein coming down in the middle of my forehead. Also due to scarring (swelling like) there are 2 shallow bulging just above both of my eye brows. What do you think needs to be done to make for a smoother and level forehead?

A: It certainly sounds like you have a depressed scar that runs down the middle of the forehead, which is not surprising with long scars that run perpendicular to the relaxed skin tension lines in the forehead. The smaller two bulges to which you refer could be either your native brow ridges (which have become more prominent due to the depressed scar/bone) or they may be extra bone formations. (periosteal reactions to the original injury) I would have to see photographs to answer that part of your forehead issue better. But let us assume this is what the forehead issues are. In this case, a scar revision of the entire forehead length can be done and the bony prominences reduced through this open exposure. It may also be necessary to do a little buildup of the bone underneath the scar will a little bone cement to help make the bony part of the forehead smooth across the original injury area.  (forehead contouring) But this would await what is found during surgery.

Dr. Barry Eppley

Indianapolis,Indiana

Q: Dr. Eppley, I am interested in forehead recontouring. As you can tell from the pictures I’ve provided, I have two prominent structures protruding from my forehead which gives the appearance of two “horns.” I would like to know if it’s possible to “shave down” these bulges for a more natural look; they are completely bone in structure that began forming when I was around 11 years old. I’m particularly interested in how the procedure might be carried out and the approximate cost of the surgery. Thank you in advance. 

A: Thank you for your inquiry and sending your pictures. Your forehead shows two symmetric areas of frontal bossing. This is to be differentiated from frontal osteomas. Osteomas can be a source of forehead ‘horns’ and they represents a growth of new bone that usually has a well-defined separation or edge from the underlying forehead bone. This makes it fairly easy to separate it with an osteotome through an endoscopic technique from two small scalp incisions. Frontal bossing projections are different in that they are expansions of the natural frontal bone itself rather than just new bone growth on top of it. Thus they must be burred down and can not be done with an endoscopic osteotome technique but rather requires more of an open incision placed back in the scalp to do the forehead contouring. They can be very easily burred down to a perfectly smooth forehead contour but requires more of an approach to do it.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in getting my forehead reduced, now I know there’s only a certain point your eyebrow ridge can be reduced but how about the glabella and the upper third part close to your hairline? Also I would like my hairline lowered but was wondering If the price would be combined all into one or do I have to pay separately and how much do you think it will cost me about?

A: When one uses the term ‘forehead reduction’ that could mean a vertical skin distance reduction by hairline/scalp advancement, reduction of forehead/brow bone bossing or a combination of both. The hairline incision needed for advancing the scalp forward can also be used for frontal bone recontouring as well. The forehead bone including the glabellar area can be burred down. How much it can be reduced would depend on the bone thickness and the location of the underlying frontal sinus. Some people have frontal sinuses that cross between the eyebrows and other have a separate sinus-free zone in the glabellar area. A simple frontal and lateral skull x-ray will show the location of the frontal sinus and the thickness of the frontal bone. This will show how much bone reduction can be done in these areas. One could expect to pay in total surgical costs around $ 6500 to $8500 for a combined hairline advancement and frontal bone recontouring.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Over 10 years ago, I was involved in a car accident and ended up getting a craniotomy and evacuation of a subdural blood clot. Afterward, the craniotomy flap got infected and had to be removed. Because I was a child at the time, some bone actually grew back over the upper forehead defect. But it was not of the same thickness or amount and I have been left with a flat and irregular upper forehead area around my hairline and into the very visible part of my forehead. It is quite noticeable and embarrassing for me and I have always wanted to get it fixed. I have read recently through your writings that it can be repaired with some types of materials that are applied to the outside of the bone. That has given me great hope that there is a solution to this embarrassing problem. I am tired of people staring it! Please tell me about this procedure and how it is done.

A: Based on your description alone, it sounds like you would be an excellent candidate for an onlay cranioplasty procedure. Compared to what you have been through previously, this is a relatively simple operation that produces immediate results. Since you had a craniotomy previously, you have an existing scalp scar. The scalp ius lifted up again and a synthetic cranioplasty mixture is used to apply to the defect and make it perfectly smooth with the rest of the forehead. The available mixtures are a powder and liquid, which when combined, turns hard after it is shaped within a few minutes. There are three specific cranioplasty materials. I would choose hydroxyapatite, specifically Mimix, for your cranioplasty as it is the most like bone and has excellent working charcteristics. I have worked with it for over 15 years, including through its research and development phase, so I know its working properties very well. This is an outpatient procedure under general anesthesia that would take about 90 minutes to do.

Dr. Barry Eppley

Indianapolis Indiana

Q: Hello Dr. Eppley, I am a 24 year old male. I wanted to ask a question concerning forehead recontouring. I dislike my big forehead as it sticks out. I want to make my forehead smaller and flatter. I see you perform surgeries such as burring the forehead bone down. My problem is the slope of my forehead above the eyebrow area. I have attached a picture for you to get a better opinion. Do you think this surgery is possible for me? Please and thank you.

A: Thank you for sending the pictures. I can see exactly your forehead concerns. There is a bulge that starts above the brow area and extends upward, stopping short of your frontal hairline. There ius no question that can be made more flat by burring. Probably at least 5mms to 7mms can be reduced down into the diploic space to remove this bulge and make your forehead more flat rather than bulged. The only issue is one of the incisional access to do the forehead contouring procedure. It is no more complicated than a traditional open browlift procedure. That means there would be a fine line scar inside your hairline from the incision needed to turn down the scalp flap. You have good hair density presently it is just unknown, like any male, what the future may hold for your hairline. The scalp scar would be the trade-off for a flatter forehead.

Dr. Barry Eppley

Indianapolis, Indiana

Q: I wrote you a couple of months ago about the possibility of undergoing a forehead contouring surgery to address my possible forehead bulging, to which you asked me to provide you with pictures. This is want I would like to do now and i have attached some forehead pictures for you to review. I don’t know whether the bulge is created by my high hairline or if it is just the way my forehead is. Basically, as previously stated, I would like to know if the problem is a high hairline or a protruding forehead, or both. At any rate, I would like to hear your surgical recommendations, or lack thereof!

A: Thank you for sending your pictures. I think there is some degree of a mild amount of forehead bulging that is accentuated by a higher hairline. Given the mild problem and the resultant scalp scar to improve it, I would not recommend any surgical modification. While it can certainly be done, the scalp scar in a male is a major limiting factor. This would not be such a rate-limiting step for surgical treatment in a female.  I have looked at hundreds of male candidates over the years for cosmetic forehead contouring and brow bone reductions and could only ever justify surgery on about 2% to 3% of them.The magnitude of the forehead problem has to justify the trade-off of the scar to do it.

Dr. Barry Eppley

Indianapolis Indiana

Q:  Dear Dr. Eppley, I wonder whether you could give me some advice about forehead recontouring.  I have a very prominent brow and two bony protusions on my forehead.  I look fine straight on but at 45 degrees I look extremely hollow-cheeked and my eyes look abnormally deep-set.  I tried cheek implants about 15 years ago (they have since reabsorbed) but of course these only made my eyes look even deeper-set.  I also have a very strong chin and nose but can’t reduce these either because they go some way to balancing out my brow line.  Would you be able to provide me with some idea as to my suitability for surgery? Thank you very much.

A: Occupying the upper one third of one’s face, the shape and size of the forehead can impact significantly one’s facial balance and appearance. Your description illustrates that quite clearly. The brow bone area, known medically as the supraorbital rims, is a bony prominence like the cheeks and chin in the lower two-thirds of the face that has cosmetic significance. When it is normal (not protruding) one does not give it a second thought. When the brow bones are excessive, however, it can change the look of one’s entire face…and changing other parts of the face will not really ‘hide’ the brow protrusion or its impact on how one’s eye area looks.

While the shape of the forehead and brows is significant, it is not commonly surgically changed. This is not because the possible forehead recontouring procedures are difficult, have high risks, or involve a long recovery, as they do not. It is because it requires an open approach with a scalp incision and a resultant scar in the scalp. For women this is not usually a major stumbling block, but for most men it is. Since many more men have forehead concerns than women, this makes the number of cosmetic forehead contouring procedures that are done fairly small.

Dr. Barry Eppley

Indianapolis Indiana