Your Questions

Q: Dr. Eppley, I wanted to know if you can greatly reduce the size of my prominent frontal bossing. This part of my skull that is currently protruding out of my forehead and causing my hair to fall out? Can it be reduced as well as  lower and restore my hairline in the process? The reason I ask this because since my skull expanded my cranial and facial appearance has been altered and I wish to revert this process. If you could please let me know what steps one usually takes from here I would be really grateful.

A: Thank you for your inquiry and sending your pictures. Your frontal bossing can be reduced fairly significantly and the frontal hairline brought forward. How much the frontal bossing can be reduced depends on the thickness of the bone. How much the frontal hairline can be brought forward depends on how much laxity of the scalp exists after it is elevated. While both can be simultaneously accomplished, one issue is that there will be a fine line scar at the edge of the hairline. This is the dual access point for both procedures. Since frontal bossing is not the source of hair loss, the long term consequences of having a fine line scar there and the fate of the hairline in the future bears giving consideration as to its advisability.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have frontal bossing on the upper forehead below the hairline on either side. Many specialists say this can be easily treated with fat grafting but what about the long term side affects? I would greatly appreciate any details.

A: The treatment of frontal bossing can take two very different directions. One is a reductive approach to frontal bossing which involves burring down the prominent forehead bony protrusions through a hairline or more posterior scalp incision. The opposite approach is an augmentative one where the areas around the frontal bossing is built up. This is usually best done by adding bone cement material to the ‘deficient’ areas around the frontal bossing also done through an incision similar to the reductive approach.

Whether one should have an an augmentative or reductive approach to their frontal bossing is one of aesthetics. Which type of change of forehead change will look the best? That would depend on the each individual patient and their degree of frontal bossing and forehead shape. I would need to see some pictures of your forehead to better answer that very important treatment decision.

The use of fat grafting in the treatment of frontal bossing falls into the augmentative approach. It differs from bone cements in multiple ways including the elimination of an incision (good thing) but with unpredictable fat survival and rarely creates a very smooth forehead contour. (bad things) But if augmentation is the best aesthetic treatment, these risks may be worth it including the potential need for a second fat grafting session. However if a reductive approach is the best aesthetic choice, fat grafting would be a poor treatment choice no matter how well it was performed or how much fat survives. One wants to avoid making the overall forehead too big.

Dr. Barry Eppley
Indianapolis, Indiana