Your Questions

Q: Dr. Eppley, I am interested in male brow bone reduction. But because of my hairline I can not have a coronal incision to do the procedure. I know that the alternative for some men is a mid-forehead incision. But that would only be for brow burring correct?  Which wouldn’t have a very big overall impact as my bone is thin. It seems the only real option is to have coronal incision which just seems very excessive. Surely there is a better way to do it.

A: Your assumption about the limitations of the mid-forehead incision for male brow bone reduction are incorrect. Total brow bone reshaping by osteotomy and bone replacement can be done through this small mid-forehead incision….not just bone burring. (there are very male patients who would get any benefit from simple bone burring of the brow bones) I have done it many times and for smoke men it is the only way to do it because of their hairline location or density. One could also use the old open sky incision at the top of the eyebrows and across the nose but this risks permanent injury to the sensory nerves of the forehead.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I want to lift the eyebrows of the forehead area and reduce the protrusion of the forehead bone but I don’t want a coronal incision to do it. I need minimal incisions as I am a male.

A:  Browlift surgery in a male is a challenge due to the hair issue or lack thereof. Male browlift surgery can be performed either through an endoscopic technique with an epicranial shift or through the eyelids (transpalpebral) with or without an endotine device. The frontal hairline and density will determine which option is best.  When it comes to brow bone reduction, however, there are no other options that a coronal approach. The male brow bone is really frontal sinus expansion and must be reduced through an osteotomy approach. Even if the brows could be reduced by simple burring, good access is needed and an endoscopic approach can not be used. For most men, the coronal incision is an understandable objection and brow bone reduction is not possible.
Dr. Barry Eppley
Indianapolis, Indiana

Q: Dr. Eppley, the forehead bone above my eyes is pumped out or sticks out which makes me looking different. It just curved out like bumps. I have good insurance which covers everything 100 % but I’m not sure if it covers plastic surgery. My questions are what is the best surgery to remove some of the bone thickness and will you accept insurance?

A: Brow bone prominence or protrusion, contrary to popular perception, is not caused by increased bone thickness. Rather it develops because of overgrowth or excessive pneumatization of the frontal air cavity sinus. Thus the large brow bones actually have a very thin layer of covering bone. To reduce them requires an osteotomy of the anterior table of the frontal sinus bone, reshaping it, and then and then replacing it. This is the only way to reduce a large brow bone, particularly in a man. This is a cosmetic condition not a medical necessary one that improves appearance but not function. Therefore  brow bone reduction surgery is not covered by insurance no matter what plan one may have.

Dr. Barry Eppley

Indianapolis, Indiana