Q: Dr. Eppley, I am interested in forehead recontouring but all of your case studies of the procedure show people with hair. I can see how an incision made for forehead recontouring along the hairline is great if you have hair and can hide the incision. But what if you don’t have hair, how would you handle that?
A: There is a reason you do not see pictures of almost any kind of forehead recontouring procedures in men who either do not have hair or have a shaved head…they do not do the surgery. The scar would not be a good tradeoff in the vast majority of men unless the forehead deformity is very noticeable or extreme. Having said that, I have done a handful of men who have no hair for forehead recontouring but they are extremely motivated and are willing to make the aesthetic tradeoff of a scalp scar.
In some cases of forehead recontouring a forehead incision through a prominent wrinkle line can be considered as an alternative to a scalp incision. This can be a more ‘natural’ and direct approach based on the age of the patient and the extent and depth of the forehead wrinkles.
Dr. Barry Eppley
Q: Dr. Eppley, I had a brain tumor surgery (meningioma) the size of a tennis ball taken out three years ago and I would like to know if bone cements for forehead augmentation/ reconstruction has any after affects. What consequence could the use of this material have on me. Where would the incision be done? How good could the outcome from forehead augmentation be?
A: I assume you had a frontal craniotomy/bone flap done to remove your meningioma and this has results in some contour deformities of your forehead. This is common as the frontal bone settles and heals with irregularities around the burr holes and the plates and screws used to fix them into place. These forehead defects/irregularities could quite easily be smoothed over/augmented by any of the different bone cements. The best bone cement to use would be that of a hydroxyapatite composition. There are no adverse consequences of this material on your bone or the overlying scalp. You would some or all of the same incision for your forehead recontouring that was used for the neurosurgical tumor procedure.
Dr. Barry Eppley
Q: I was wondering if it is possible to shave down certain parts of the skull. My forehead isn’t the way I want it to be shaped. I am trying to get my forehead to stick out a little less. Is it possible to shave the skull down? And if so how much can be taken off?
A: The thickness of one’s skull can be taken done by burring. How much it can be reduced is determined primarily by the thickness of one’s outer cortex. The skull has three bony layers, an outer hard cortex, an inner spongy marrow space and and an inner hard cortex. While the burring reduction can be taken down past the outer cortex into and through the marrow space, that causes a lot of bleeding and can make for an irregular surface. Therefore for practical reasons, the outer cortex is usually the only skull thickness reduced when done for cosmetic purposes. That can vary in different skull areas but in the forehead in a man, that may be up to 5mms or so.
The more significant rate-limiting step for male forehead reduction is the incision needed for access to do the procedure. A scalp incision is needed to turn down the scalp so the bony forehead is exposed for reduction. Given the unstable frontal hairlines and hair densities of most men, forehead surgery of any kind may not be worth the trade-off of a scalp scar.
Dr. Barry Eppley