Your Questions

Q: Dr. Eppley, I am interested in forehead reduction. I was wondering if it’s possible to even out my forehead and make it smooth and symmetrical? I am bothered by the sides areas of my forehead which I have marked in the attached pictures.

A: What you have are prominent anterior temporal lines on each side of your forehead. This is not really due to a prominent forehead per se but due to a deficient temporal muscle on the side. This makes your forehead look very square and boxy. Rather than burring down the temporal lines (forehead reduction) I would recommend extended temporal implants to build up the area beside the forehead. This would be simpler and would create a more masculine forehead as opposed to burring down the bone and making your forehead rounder. (although that could be done based on your personal choice)

The aesthetic problem with temporal line reduction is that it will require a scalp incision to be done which is challenging to place in male without some visibility. Conversely the small temporal incisions for placing extended temporal implants are in the temporal hairline and are much less of an aesthetic concern.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a hairline advancement (forehead reduction) surgery one month ago. I’m losing some hair on the scar and was wondering how long will it take before it grows back? Im still not too happy about my head. I don’t feel like I can wear my hair back. I still feel my hairline is high. My husband says it looks good however! Thanks.

A: There are limit to a one-stage hairline advancement surgery based on teh scalp’s elasticity and how much the forehead can be reduced. Hair shafts along the incision line will typically shed in the first few weeks to month after surgery due to the trauma of the surgery. (hair follicles do not like traumatic events) This still leaves the follicles underneath the skin/scar which will regrow hair, at the growth rate of 0.05mm per day (the follicle lies 6 to 8mms under the skin), which will take about 8 to 10 weeks to begin to appear at the skin surface. (1mm per 10 days or 3mms per month) Thus it will take around three months until some hair growth has occurred through the scar. This coincides with when the redness of the hairline scar begins to get better. (less red) Between the hair growth and the maturation of the frontal hairline scar, it will take about 6 months for the appearance to become more normal. It takes up to a year for the scar to fade as much as it is going to and to have enough hair growth length to see the final true hairline location and pattern.

While easy to stay, it takes patience and lot more healing time to really judge your final perception of the surgical result.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in a frontal hairline advancement. I have no issues with hair loss. My hair hairline simply dips back into in the middle and that’s where I drew a line if that was eliminated on my picture. I have some breakage on the edges from hats and headbands, but nothing permanent. It grows back instantly. Is this possible? I know you are the best at this procedure so I thought I would ask you.

A: Thank you for sending your picture. Where a hairline advancement works the best is exactly where your hairline issue is….in the center of the frontal hairline. Given where you have put the markings for the desired hairline edge I think is a very achievable goal. Scalp elasticity always determines how much the hairline can be moved but a 1 to 2 cm forward movement is possible in most people. It is at the sides of the hairline advancement, the temporal region, where a hairline advancement has the least effect…unless the incision is placed right at the edge of the hairline which would usually not be desirable for most patients. This is a procedure that has a very quick recovery so expect to be back into a normal life within 7o to 10 days after surgery.

Dr. Barry Eppley
Indianapolis, Indiana

Q: Dr. Eppley, I am interested in forehead reduction. I have had 3500 FUE strip harvest hair transplants done five years ago. While the grafts have taken well without hair loss I have a remaining large forehead. I still have some elasticity to the scalp and am interested in seeing what a forehead reduction can do.

Q: The key element of a successful forehead reduction (and I assume you mean hairline advancement and not bony reduction) is the scalp elasticity as you have already noted. That scalp elasticity comes from the back of our head primarily and not so much the top when the scalp is advanced. If you have had 3500 transplants that would indicate to me that you have had at least two harvests procedures and a linear scar exists across the back of your head. (unless it was done by Neograft or Artiss) That does not bode well for much scalp mobilization no matter how loose it may seem. (although I can not say for sure about the scalp elasticity just by looking at pictures) Secondly there is also the issue of needing a frontal hairline incision. This is always a little bit more risky for prominent scarring in men as opposed to women. Hair density along the frontal hairline is important so that issue also needs to be considered.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hello when I was little I had an accident that involved me hitting my forehead on a wall which lead to me being stitched up and left a scar in the middle of my forehead. It left a big bump on my forehead and just doesn’t look normal compared to a normal male forehead. It just sticks out and I guess you could say it’s deformed due to the trauma I had with the accident. So my question is what are the possibilities of shaving down the top/frontal part of my forehead to make it a more sloped appearance and the recovery time for this procedure?

A: It is certainly very possible to burr down any forehead prominence to reduce its visibility as well as provide more slope to the forehead. This type of forehead reduction is possible because the frontal bone is very thick so such a reduction is very possible. The only question is how to access the forehead as an incision has to be placed somewhere. That is the only important question. Whether it is at the frontal hairline (pretrichial) or somewhere back in the hair line is the more challenging question particularly in a male.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, my forehead bone has grown from from normal to abnormal. Because when I was young almost 10 years old I had fibrous dysplasia. I had an operation in 1999 and it started growing up at the age of 19 but then stopped at the age of 22. It is not growing anymore. I want to know now that it is not growing anymore if it is possible to make it normal? MANY THANKS

A: Thank you for your inquiry and sending your pictures. I can see that your brow bone has grown disproportionately compared to the rest of your forehead. Because the origin is fibrous dysplasia, your brow bone may well be completely ossified as opposed to be a large air-filled bone cavity. That could be determined by a CT scan. But regardless of what constitutes the brow bone protrusion, the surgical technique to reduce it is basically the same. I assume because you have had a prior operation that you already have an existing scalp incision/scar. This makes brow bone reduction ‘easy’ because there is not a concern about the method of access to do the surgery. Dramatic reduction can be done on your brow bones to get their appearance much more normal looking.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I was born with a good amount of frontal bossing. It got better as I aged but it’s still there and very noticeable, especially when my hair is cut short. This is something that has bothered me every single day for the last 5 years now. I also believe the muscles on the side of my head protrude out and this adds to the awkward appearance. My question is that do you think the mid/upper and sides areas of my forehead can be reduced by burring away some of the bone? Would it be possible to say if I have excess bone or just that my skull was formed with a protruding appearance? If this was done, could I still play sports? What I mean by this is that would the area be much more easier to fracture if I happen to take a blow to the head? How does frontal bossing even occur and what is the average size of the frontal bone in men? .How bad will the scar be and what would something like this cost? My last question is how many of these types of surgeries have you performed and do you think I would benefit from this surgery? I apologize for all the questions but I tried to sum it up as best as I could. Thank you for your time.

A: Forehead bossing /protrusion occurs for unknown reasons. Significant size reduction can be obtained by an overall burring reduction of the entire forehead side to side between the temporal lines. Such reduction can accomplish a reduction of 5mm to 6mms throughout which is very significant on the forehead. I have done this type of forehead reduction surgery numerous times and have always been impressed with the difference it makes. Such forehead reduction will not make your skull weaker or more prone to fracture. The procedure is done through a fine line incision in the scalp (no hair is shaved) and that scar can heal remarkably well in my experience.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m interested in getting a forehead reduction with the hairline lowering included. However the bossing of my forehead is the entire bone, top middle and down to the bottom over the brow bones. Can these areas be burred and reshape with the same approach you use on the brow ridge and eye orbits sockets as well?

A: The entire forehead can be reduced by burring. The only exception or caution would be over the brow bones where the underlying frontal sinus exists. The bone on the front of the frontal sinuses (brow bones) is usually very thin and may be only 3 to 4mms thick before the frontal sinus is encountered. A lateral skull film x-ray is needed before surgery to measure the thickness of the bone to see how much it can be reduced by burring. If more reduction is needed than just burring can allow, then an osteoplastic bone flap technique is needed to maximize the lower end of the forehead reduction. In a woman this is rarely needed however.

That is a long answer to say that a burring technique can sufficiently reduce the amount of bossing of the frontal bone and is often done on conjunction with a hairline lowing/advancement.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had very prominent brow bossing which I had burring done on by a physician who doesn’t perform these procedures frequently. After the burring, my brow ridge looked better, but I am left with strange indents on my forehead. My surgeon attributes this to scar tissue forming from where he burred the bone down, so he injected steroid into two spots on my forehead, which have resulted in additional dents. He has said he will fix the steroid dents free of charge but I really just want someone’s opinion who performs forehead procedures. I’m so bummed my forehead looks worse than before 🙁 is there any way, preferably the most conservative available option, to correct this? Thx so much for your time.

A: It has been my experience on any type of forehead or skull reshaping by burring that the final shape seen on the outside is a direct reflection of how the bone looks underneath.(particularly when adequate healing has occurred after three months) Scat tissue forming irregularities is not something I have seen. Even though the forehead and scalp tissues are quite thick, it will not hide even the slightest irregularity on the underlying bone when it is fully healed. Injecting steroids is not going to solve these irregularities (because they are bone based) and has a high risk of making them worse by shrinking the fat under the skin.

The only minimally invasive way to try and fix these forehead contour issues now is injectable fat grafting. But the unpredictability of fat take after injection has its own issues when trying to correct relatively small forehead contour issues.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in forehead reduction surgery. I have always had a high forehead and I have been embarrassed about it most of my life. I do my bangs everyday cause its all I can do to cover it and I get stares constantly everywhere. I wanna be like a normal person so I can get up out of bed and run out the door without having to do my hair. I don’t even get the mail unless I do my hair. I don’t even wanna go out and play with my kids unless my hair is done. I don’t get in the pool with them because I don’t want to get my hair wet around people. I want to know if I would be a good candidate for a one step procedure because I don’t want my head inflated with a balloon.  Thanks so much!! (sorry my pics are horrible but I can’t do anything with my hair cutting wise or color)

A: Based on the picture you have sent, I can see your concerns about a high and broad forehead. While the picture may be somewhat distorted because of the fisheye lens effect from a cell phone camera, there is no question that you have a high hairline and what appears to be frontal bone bossing. I would need to see a side view that is not so close-up to have a better appreciation for the hairline position and how much true frontal bossing you really have.

You would definitely need a combined frontal bone reduction and frontal hairline (scalp) advancement. The key to whether a single stage procedure would offer enough benefit to make the effort worthwhile depends on how much your scalp can be advanced. That would be a function of how much natural flexibility it has (looseness) and how much it can be mobilized. There is also the question of how much hairline advancement do you need to make a difference and what is the location of your temporal hairline. (which is the most resistant to any significant forward movement. More pictures would help make those issues somewhat more clear.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in one-stage frontal hairline lowering? How big will the scar be? As long as the scar isn’t noticeable, I’m definitely interested. How long is surgery? How long is recovery? Will I have to take any medication before surgery? Will I be completely out? Will I accomplish what I’ve wanted all my life, to be able to wear my hair off my face/forehead immediately?

A: For forehead reduction/frontal hairline lowering, there are two techniques based on how much advancement of the frontal hairline is needed. If the amount of advancement is in the 1 to 1.5 cm range, then it can be done in a single operation. Larger amounts (> 2.5 cms) would require a first stage placement of a tissue expander to create the amount of scalp needed to move forward. Frontal hairline lowering is done through a hairline or pretrichial incision and is best thought of as a ‘reverse browlift’. Instead of the forehead skin being lifted from the pretrichial incision, the scalp behind is advanced forward and forehead skin removed where the new hairline will be. While this does place the incision/scar right at the new hairline, it usually heals very well and is barely detectable in patients with little pigment in their skin. (Caucasians) It is a procedure performed under general anesthesia and takes about an hour and a half to complete and is done as an outpatient. Recovery is very quick and there is no swelling of the eyes that is usually seen. One can shower and wash their hair the next day.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, i want my forehead made smaller with a shorter hairline. I would like to have a procedure at your facility to have the central frontal bone vault reduced to about 5mm and the glabella the triangular area in between the eyes over the nose and under the brows,I had a interview with a previous surgeon who was actually to far from me to travel but he was saying my scalp is flexible   Enough to bring it down to 2 cmd maybe another half once he loosened this area underneath my scalp. I forgot the name of it,do you have any idea what he’s referring to and do you use this same technique?

A: You are referring to a hairline advancement procedure as part of an overall forehead reduction. This requires the scalp be loosed up so it can be brought forward and the hairline lowered. The more natural scalp flexibility one has, the easier and more hairline advancement that can be achieved. This is often done with frontal bone remodeling such as frontal bone reduction and some brow reshaping/contouring. You are correct in assuming that about 5mms of frontal bone can be safely reduced by burring.

Dr. Barry Eppley

Indianapolis, Indiana

 Q: Dr. Eppley, I am looking into hairline lowering, jaw reduction with male liposuction (chin too long), brow reduction (I believe I will have to have my brow cut off and reshaped. Also, I have heard of a procedure called the FROST procedure for hairline lowering without a tissue expander. Do you perform this procedure? I have a high forehead and want to make sure it is right.

A: Hairline lowering in men is unique because of the important and unknown stability of the male frontal hairline. The patients has to be selected carefully based on their hairline pattern, density, age and genetics. Having done numerous male procedures that involve an incision along the frontal hairline (hairline lowering, pretrichial brow lifts, brow bone reductions), I have always been impressed with how well the scar usually does despite an always concern about it. Interestingly, recent published research has shown that the hairline incision (in women) seems to preserve hairline stability. (whether the same is true in men is speculative but not necessarily proven) The amount that the hairline can be moved forward depends on the natural stretch of one’s scalp and the technique used to do it. While there is no question a tissue expander always ensures the maximum amount of hairline advancement, most patients do not want that two-step process. (particularly men) There is nothing new or unique about the FROST procedure for hairline lowering. It is a good acronym for the technique but is an approach that I commonly use in men or women. Most surgeons think of hairline lowering a raising up a portion of the top of the scalp to bring it forward. This more limited approach to hairline lowering will usually not get more than about 1 cm of movement at best. But if one raises the entire scalp (behind the hairline incision) in a subgaleal plane the whole to the bottom of the back of the head, scores the galea for further release and then secure its anterior edge to the desired position on the frontal bone with transosseous sutures, advancements of 3 to 5 cms are possible. (this is what is done in the so called FROST procedure) It is just a more aggressive form of scalp mobilization that many surgeons may not feel comfortable doing.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in a hairline advancement. I have been looking at your website for a while and you’re the only doctor I’ve found who may be able to perform the surgery I want. My forehead sticks out and bit and I would like to shave it down just a little to make my forehead flatter. I was wondering if this would be possible judging by the images I’ve attached. I’m also thinking I’d like to get my hairline advanced just a little bit. The area I’ve shaded is about the area I’d like to get it reduced to.

A: It is very common for a frontal hairline advancement and a bony forehead reduction to be combined together to create the changes you have shown. You have mentioned that you want just a ‘little hairline advancement although your images show a hairline advancement that I would judge to be up to 10 to 15mms. (which for a hairline advancement would not really be judged as little, that is usually the very maximum that can be achieved in a single stage procedure in just about anyone and even that depends on how much natural laxity of the scalp one has.

What is not very common is to have a male request or to actually do a male hairline advancement. I have done them it, it is just a procedure that is much more commonly done in women. The reason being is that most women have a stable frontal hairline while that is certainly not assured in men. This there is always the concern about placing a fine line scar along a hairline that may or may not be there in the future. While there is no alternative to having an incision to do a bony forehead reduction, there is an alternative (hair transplantation) to a hairline advancement.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in learning more about the forehead reduction (hairline lowering) surgery. I genetically have a very high forehead that I’ve always been very self-conscious about. I’m just now learning this surgery exists! I live out of state, so I can’t easily come in for a consultation. How do you handle out of town patients for consults? Can you just use the photos? With that, I’d also like to know the approximate cost of this surgery (or can you estimate based off pictures?). I would appreciate any information you can provide, and please let me know what other information I can provide to you. At this time, email is the best way to contact me. Thank you, and looking forward to hearing back from you!

A: Forehead reduction surgery can be beneficial for those women that have a long forehead,  which almost measures greater than 6.5 cms from the eyebrow to the hairline. Vertical forehead reduction is a skin operation where forehead skin is removed along the hairline and the scalp is advanced in its place. This requires an incision along the frontal hairline and is very much like a reverse pretrichial browlift. The success of the procedure is primarily based on how much natural looseness the scalp has and how much can be surgically created. It is this looseness that allows the scalp to be brought forward. Generally about 10 to 15 mms can be gain in most patients. If the scalp is very tight or the amount of scalp advancement needed exceeds 15mms, then a first stage scalp tissue expander needs to be placed. You can determine how much scalp advancement is needed by taking a mascara pen or lip liner and drawing a line where you want the new frontal hairline and measuring it. Also remember that the greatest amount of scalp advancement is in the middle and becomes less so as it tapers to the sides into the temporal scalp.

We have many far away patients and further discussions can be done by phone or a Skype video consultation. It is not necessary to come in for a separate in-office consultation. The cost of the surgery is very similar to a pretrichial browlift, as I have mentioned, and my office will pass along the cost to you in a separate e-mail in the next few days.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in forehead reduction surgery. I serve in the military and I really want this forehead reduction done. I hate my forehead. It is wide with a high hairline and my forehead protrudes. Please help me! I would love to do the military program but this procedure is not on the list.  Attached are some photos which shows how high my hairline is and how my forehead bulges out.

A: While you would be a good candidate for a forehead reduction or scalp hairline advancement, it appears you would need almost a 2 cm advancement given the length of your forehead. This means a first stage scalp tissue expander is placed to create more hair-bearing scalp that then can be used and advanced to create a really significant forehead reduction as a second procedure. Without a tissue expander or a two-stage approach, the most hairline advancement that can usually be obtained is around 1 cm. While forehead bone reshaping would be also be done, the forehead always seems to stick out more when the hairline is way high and the upper forehead is sloped backwards. Even a hairline advancement procedure alone make a prominent forehead look less protruding because its total vertical length becomes less.

The Patriot Plastic Surgery program applies to all elective aesthetic plastic surgery procedures.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in forehead reduction and hairline lowering. I would like to know if Im a great candidate for the forehead reduction and hairline lowering. I hit a brick wall when I was younger and that is how I have bumps on my forehead. Can you please respond back to me thank you!

A: Thank you for your inquiry and sending your pictures. I can clearly see your motivation for the forehead reduction and hairline lowering procedures with a long and high forehead and a large  protrusion of the frontal bone. You are correct in making the assumption that these two procedures would be of benefit. A less protruding forehead and a lower hairline would be very aesthetically advantageous. The key procedure of these two is actually the hairline lowering as a hairline that was 2 to 3 cms lower would help disguise the forehead protrusion significantly even though it can be reduced by burring somewhat. However, your scalp skin looks fairly tight, as most high foreheads are, and no more than about 1 to 1.5 cms of advancement could be obtained by simple loosening it up and bringing it forward. You would be better served by a first-stage scalp tissue expansion to create more hair-bearing scalp to bring forward. Then the second stage could be a large scalp advancement and bony forehead reduction. This would produce a much better result than a single stage procedure.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in some type of forehead reduction. I am a young woman and I’m not happy about my face at all. The biggest problems I have are with my jawline and my frontal bone. I also have really deep insetted eyes. I’m kinda chubby but I used to be skinny and I had to exact same problem. I have big cheeks , something like squirrel cheeks and jowls on the side of my face. I really want a nice tight jawline. When I tighten the skin together and pull it through my ears I see it the way I would want it to be. I was wondering if that is possible for me without having a jawline surgery.

I have a very big frontal bone and I would love to have a nice flat forehead like most women have. I was wondering if that is possible for me to get it flattened. Maybe there is also someting you could do for my deep insetted eyes. I want to send you some picture’s and I’m wondering if you could look at them yourself and if you have any tips for me to make me as beautiful as possible.

A: Thank you for your inquiry and sending your pictures. The most effective procedure that you could do for your face would be a combined orbital/forehead reduction and hairline scalp advancement. This would reduce the depth of your eyes, lessen the brow ridge prominence, and make the forehead look smaller.

Only a jowl lift can create the desired look you are after along the jawline and you are too young for that procedure. There are no non-surgical methods that can create the same effect.

Dr. Barry Eppley

Indianapolis, Indiana

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

Indianapolis, Indiana

Q: Dr. Eppley, I’m trying to achieve a more aethetically appealing face, by whatever means necessary. I’ve noticed my forehead protrudes in respect the level my eyes are at, making them look sunken and my face more masculine. I don’t believe it’s my bossing that sticks out, just my forehead in general, so i’m not sure how much of a result I would see with surgery. I’ve been told my nose is large, so I’m considering rhinoplasty as well. Additionally, my lips appear to almost “hang off” my face. I know this isn’t your forte but do you believe jaw surgery could be a solution? In general, I was just wondering what procedures you would recommend. Thank you for your time and I look forward to hearing from you!

A: Thank you for sending your pictures. I have done some imaging predictions based on the one side profile that you sent. What I have done is a forehead reduction, rhinoplasty and chin augmentation . If you look carefully at those changes, the most dramatic effects come from the rhinoplasty and chin augmentation. The rhinoplasty is key because your forehead and brows look so pronounced because you have a very deep radix. (root of the nose). One of the key manuevers in your rhinoplasty is the buildup of the root of the nose. By doing so that makes the forehead less retrusive in appearance alone.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, My forehead it’s very high and it also sticks out, I feel it takes the beauty away from my face. Is there a surgery to fix it and if there is I would like to know if it is too risky?

A:  The high protruding forehead is usually due to a combination of a hairline that is set back too far and the forehead bone having some degree of protrusion to it as well. It can be treated through a combination hairline lowering (scalp advancement) and burring bone reduction of the upper forehead bone. This procedure is very safe and has no significant risks to it…other than a fine line scar along the frontal hairline. Whether you would be a good candidate for this procedure would depend on how much laxity is in your scalp and the pattern and hair density of your frontal hairline. A review of any pictures of your face/forehead from the front and side view would be very helpful in determining if you are a good candidate for this forehead reduction procedure.

Dr. Barry Eppley

Indianapolis,Indiana

Q: Dr. Eppley, Where do you do surgery? What are the facility fees? What would the price be to narrow or burr the chin just at the bottom edges to make it look less square? Also, I have a flat forehead in the center with prominent eyebrow muscle, which makes the flat forehead area look flatter. How wold you fill in the flat forehead or the center of the forehead in a female? Fat injections? What would the price be?
And can you shorten the forehead skull if the hairline is a little high?

A: In answer to your questions:

1) My cosmetic surgeries are done in a private outpatient cosmetic surgery center. The operating room and anesthesia fees are based on the time that it takes to perform the procedure(s). That must be determined on an individual patient and the specific procedures they are having.

2) Narrowing the chin is done by intraoral ostectomies or removing the sides of the chin through a reciprocating saw technique.

3) A flat glabellar area can be built up by a variety of techniques with fat injections being the simplest to perform.

4) If one’s frontal hairline is too high, its length is not going to be lowered by reducing the height of the skull as that amount of skull height reduction can not be done. Shortening the long forehead is done by a procedure known as scalp or frontal hairline advancement.

I will need to first review some pictures of your face to see exactly what needs to be done before the costs of the procedures can be provided.

Dr. Barry Eppley

Indianapolis,Indiana

Q: Dr. Eppley, Hello, I am a 19 year old female with a high rounded hairline. I’ve always been picked on and teased due to it. Causing me to quit sports in high school because of my bangs blowing back when I’d run… Im always hiding behind my bangs but unfortunately I won’t be able to in Navy boot camp in six months . I am enlisted in the delayed entry program for the US Navy and I just know that in boot camp the RDC’s will make fun of my hairline as a part of breaking me down. I just want to know if your facility does any sort of military discount for the hairline lowering procedure? Or if fees can be waived out of generosity. I don’t know how that works but I figure it’s worth asking. If this is not possible, thanks anyway for your time!

A: Thank you for your inquiry. A hairline advancement/lowering can be a very effective method forehead reduction if one fulfills three criteria. First the scalp must be naturally mobile enough that it can be moved one to two centimeters forward. You can have a pretty good idea of that by pushing around your own scalp and seeing if it moves forward anyy. Secondly, one has to  have a good frontal hairline with adequate follicular density to position a well-designed incision. Lastly, one has to be willing to accept a permanent fine line scar along the frontal hairline. Please send me some pictures of your forehead for my assessment. I have asked my assistant to pass along the cost of such a procedure to you and she is the one to whom you can direct your financial questions.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have some skull and face asymmetry from positional plagiocephaly. The main issue is that the right side of my forehead bulges, is it possible to reduce this bulging so my forehead doesnt have such a broad appearance when viewed from one side? Also the left side of my face is less prominent, maybe you could say “weaker” than the right. Would some sort of implant help with the asymmetry and make the left side as prominent as the right?

A: Plagiocephaly produces the exact face and skull asymmetry that you have described. Your right-sided forehead protrusion and smaller left face are common. Although I have not seen any pictures of you, your theory for improvement in facial symmetry would be the correct approach. Reduction of the right forehead bulging and augmentation of the left face, most likely that of the left cheek and jaw angle, could offer visible improvement. I would need to see some pictures of you, particularly a straight-on frontal view, to confirm if this approach would be helpful.

The left facial implants can be placed from inside the mouth so there are no scar trade-offs for those improvements. That can not be said for the forehead reduction in which the scalp scar trade-0ff must be considered very carefully, particularly in the a male patient.

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: Dr. Eppley, I have an weird forehead. It has that I mainly have a brow as a man and it also has horns (exotosis) I was wondering if you do such surgery to fix this/shave down my skull to get me a desired smooth forehead as a female should have. I also have a high hairline so I’m wondering if you can pull it down. How old do you have to be? I know 18+ but the skull doesn’t finish developing until what age? I am 20 so I don’t know if I am old enough yet. Also, can both surgeries be performed at the same time?

A: The skull is largely finished developing by one’s early teens, it is the facial bones below it that continue to develop until the late teens with the mandible finishing complete growth around age 21. Therefore, at age 20 you can have frontal/brow bone reduction without any concerns about growth implications. The only issue is how much the brow bones can be reduced given the frontal sinus which lies underneath it. That could be determined before surgery by a simple lateral skull film. The hairline advancement/vertical forehead skin reduction is done through a pretrichial incision. This also provides the exposure needed for the forehead and brow reduction so, by necessity, these two procedures would be performed at the same time.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am really interested in forehead reduction/hairline lowering. I am 21 years old and have not been able to find any local surgeons that can perform forehead reduction surgery. My forehead is incredibly long from the top of my eyebrows back to my hairline. It is like the entire front part of my skull is way in front of my hairline. I am looking for more information as to how this procedure is done and what my options are. I have sent some pictures so you can see for yourself my issue.

A: In looking at your pictures I can see the amount of frontal and temporal recession of your hairlines. You forehead is at least 8cms if not more. While vertical forehead skin reduction and hairline advancement can be done, its success and method depends on how much laxity or looseness your scalp has. Using the natural scalp laxity that can be obtained by surgical release, you will likely get a 1 to 1.5 cms advancement in the midline of the forehead and less so as it tapers into the temporal area. Up to 3cms or more can be obtained with a two-stage approach using a tissue expander first, followed by a second-stage scalp advancement. To find out what you need and which method may be best for you, do the marking test. Trace out the desired hairline with eyeliner pencil and then do a measurement to see how much advancement in centimeters that you need. Also take a feel of your natural scalp tightness by pushing forward on it and see how tight or loose that it is. These are the tests I would do if you were sitting in front of me to answer what method is needed to achieve your forehead reduction goals.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I desire a smoother, lower forehead. Currently I have indentations on each side of my forehead that run all the way down to my cheekbone arches. I would really like to have those indentations filled in using bone cement or some other reliable material. I also have a high forehead and would like to have it lowered. My forehead looks big and masculine right now and does not fit well with the rest of my face. I have attached pictures of me for your review.

A:  The indentations to which you refer are the temporal fossa, which is largely a soft tissue space filled with the temporalis muscle to the side of the forehead. It extends from the anterior temporal line at the edge of the forehead down to the zygomatic arches inferiorly. While these could be filled in with bone cement deep under the muscle, that would not be my approach and could be improved much more simply. Silicone temporal implants can be placed under the deep temporal fascia and on top of the muscle. This is a more effective, reliable and cost effective technique.

When you speak to a large forehead, I am assuming you mean a high one in which the distance is vertically long from the eyebrows to the frontal hairline. That is different that a large forehead in which the frontal bone is bossing or prominent. While the forehead can be vertically shortened by a centimeter or so through a frontal hairline advancement and skin excision, I would be very cautious about performing that procedure in you. A forehead reduction results in a scar along the frontal hairline. In pigmented skin types like yours, I would be concerned about how such a scar may turn out. Hair density and hairstyle is also an important consideration is deciding about the aesthetic merits of a forehead reduction procedure.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am hoping to reduce the size of my bulging head and brow bone to get an even and a more natural look. Please take a look at my pictures and tell me what you think.

A: There is no question that you have a significant forehead bulge or protrusion. In looking carefully at your pictures you can see a narrowing behind the forehead bulge running down the sides of the skull exactly where the coronal sutures would be. This suggests the reason for your forehead bulging is some variant of coronal craniosynostosis, probably a partial craniosynostosis deformity. Whatever the reason does not change how you might approach forehead reduction. While the most effective procedure would be removal and reshaping of the entire forehead bone flap and the skull bones behind it, this type of craniofacial surgery can only be done in infants and not adults. This is due to the inability to mold bone in an adult skull. Therefore, the only option as an adult is whether external bone reduction by burring would make a significant difference. That question can be answered by plain lateral skull x-rays. This x-ray would allow a measurement to be made as to the thickness of the forehead bone and, more specifically, the thickness of the outer cranial table and underlying diploic space. If up to 5 to 7mms of forehead bone can be reduced over the entire forehead, this may make enough of a difference to justify this approach to forehead reduction.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley,  I just had a quick question regarding the forehead lowering procedure. I want to get my forehead lowered however I have a “Y” shaped vein that runs right down the middle of my forehead. Is it still safe to perform the surgery with this and have you ever personally encountered this? 

 A: Many people have prominent veins in their forehead that undergo browlift and hairline type procedures. Because the veins are in the subcutaneous level of the forehead tissues, they are out of the plane of dissection which is at the deeper subperiosteal level. So they do not pose any ‘risk’ for a hairline lowering/forehead reduction surgery. If the vein(s) crosses into or from the frontal hairline, it will be tied off or cauterized in a hairline advancement as it will be encountered in the dissection from the skin down to the bone. Either way, veins are not an issue in any type of forehead surgery.

Dr. Barry Eppley

Indianapolis, Indiana