Q: I would like my brow bones enhanced but I think I only need the outer 2/3rds of the browbone or even just the outer 1/3 (the area underneath the eyebrow) plus a little bit on the temple that’s connected to the brow. I want the area to look flat but padded up and not stuck out like a ridge. I don’t want to end up looking like a neanderthal. So I think only the outer brow bone needs enhancement but I do not know how it would look esthetically in practice. I’m not a plastic surgeon. Have you done many outer 2/3 of the browbone enhancement surgeries before? How do they look? Would you mind sending me some before and after pictures? I am thinking of getting juvederm to the area first to see how it would look with the permanent filler. Should i do that? I also have a low nose bridge which I want to enhance a little bit. If you don’t mind I’ll send pictures. What are the chances of scarring with the upper eyelid approach? Where is the incision going to be? In the eye crease? I think saw you mention to someone else the Q&A about preparing the periosteal, what does that mean? Why do you prefer the hydroxyapatite paste instead of kryptonite bone cement for this procedure? I’m sorry for asking too many questions Dr. Usually when you search about enhancing the brow bone on the web, only the stuff about silicone forehead implants come up, which seems rather drastic and scary to me. You’re the first Dr who have said the 2/3 browbone enhancement is a viable option.
A: For the area of brow bone that you want enhanced, an upper eyelid approach is the best way to go. It is much closer to the bone area to be augmented and is done through an upper eyelid crease incision. This is the same incision used for standard upper blepharoplasty procedures. The material of choice is hydroxyapatite cement. This material must be placed through an open incision, contours nicely, sets up quickly, and is less expensive than Kryptonite bone cement. Many people are enamored with the injection approach with Kryptonite but they misinterpret it like it is the same as injectable fillers for soft tissue. It still requires an open pocket dissection and then must be contoured from the outside by hand without actually seeing the bony contours. That may be fine for a large skull area but when it comes to working with very discrete contours this is not good and will very likely pose irregularities that will have to be revised later.
The tail of the brow can be either reduced or augmented (lateral brow bone augmentation) through the upper eyelid approach. I have done both very successfully. A scalp approaach is needed, however, when the entire brow needs to be modified.
Dr. Barry Eppley