Q: I am a 24 yr. old Asian female interested in augmenting my brow line. I’ve attached a photo of myself and another person with a protruding brow line. I don’t expect to look like the second photo after surgery but I’m using it to get my idea across. About a year ago, I had fat injections to my eyebrow area, but I saw little to no results after the procedure. Now I am considering different options for more noticeable results. The other options I am considering are – implants, bone graft, bone cement, or filler. I would like to know if you’ve performed these procedures and I have a few questions concerning them:
- Where will the incision be?
- What is the possibility of infection?
- Is there the risk of facial nerves being damaged during the procedure?
Thank you in advance,
A: I have performed brow and forehead augmentation/cranioplasty with numerous materials over the years. In answer to your questions regarding brow augmentation:
1) You can look like the picture if you want. It is all a matter of how much material is added. There is not much limit to what can be added.
2) A scalp or coronal incision is used for access to the brows.
3) Infection is always a possibility but rare in scalp procedures. So rare that I have not seen it in my practice career.
4) There is no risk of facial nerve injury.
Also, without question, cement is what you want to use for brow augmentation. Not implants or bone grafts. Cements can be molded and shaped to the bone and are permament.
I hope this is helpful. Let me know if you have any further questions.
Dr. Barry Eppley
Q: Hello Dr. Eppley. I would like to inquire about brow bone implant. Do you mind taking the mind to answer some of my questions? 1) Are there any limitations to brow bone implant? Can it stretch as much as we want? 2) Will the eyes change its expression after the implant? I tried pulling out the skin at my eye brown area and there seems to be a difference. 3) Will the eyes appear bigger or smaller after the implant? 4) Lastly, is lowering my eye browns accurate to determine how I would look like after the brow bone implant? Thank you for your attention. Hope to hear from you soon.
A: In answer to your questions about brow bone augmentation, let me clarify that building up with brow area is done using typical cranioplasty materuials and not just a carved or pre-shaped implant. With that being said: 1) The size of brow bone augmentation can be done to just about whatever size someone wants. 2) The muscle activity around the eyes will not change after brow bone augmentation. But a stronger brow appearance may make the eye area look different. 3) While the actual size of the eye will not change after brow bone augmentation, they may look little deeper set in some patients. 4) The horizontal position of the eyebrows does not change after brow bone augmentation. They are pushed outward and perhaps a millimeter or so downward but they do not shift downward to any significant degree.
Dr. Barry Eppley
Q: I have very prominent brow bones and want to get them reduced. What would cause the frontal sinus space to become so prominent? I have an older brother who has a nice flat brow bone and forehead. Conversely, my father has somewhat of a prominent brow but not quite as large as mine So could it be just genetics? Or could it be from falling on my forehead when I was younger? As far as brow bone reduction surgery goes, I have read that it involves a scar across the top of my head. Given my hairline this is not very appealing. Is there a way of going between the very top bridge area of the nose and bottom of the brow to contour it that way and bypass the hairline all together?
A: There is no known reason that the frontal sinus expands to such a large degree, short of the presence of a sinus tumor. It has nothing to do with trauma and is just purely a genetic blueprint issue.
There is an alternative to a scalp or coronal incision which is done directly as you have indicated. It is an incision done directly across the brow bone area, being just at the brow hairline margin and then coming across the middle by stepping done into a horizontal skin crease between the top of the nose and the forehead area. This is known as the ‘open sky’ approach and has an historic use for the treatment of fronal sinus fractures and tumors. For most men, it is a better option for brow bone reduction than a scalp incision and would be less noticeable. It would also make the surgery less traumatic and involve a quicker recovery. It does heal as a very fine line scar. If one’s brow is big enough and disconcerting enough, this is a reasonable approach.
Dr. Barry Eppley
Q: Hello Dr. Eppley I am a 28 year old male with an extreme prominent brow ridge. I have been doing research on this and understand the male vs female forehead anatomy. It seems my brow is quite larger than a typical caucasian male and was wondering if I went through a surgery for this what would be the result. I’m certainly not looking to become “feminine” by any means. I am a heterosexual male, but the size of my brow makes me feel uncomfortable and self-concious. I have a cephlometric x-ray of my profile view so you can see the size of the brow and maybe show me how much of a change is possible. Thanks for taking the time to read this, it’s a great website you have which is very informative.
A: Thank you for sending your ceph x-ray. There is no question that you have a very large pneumatized frontal sinus air space which is the cause of the prominent brow bones. The size of those brow bones are very good candidates for significant reduction through a brow bone reduction osteotomy technique. This is done by removing the outer table of frontal sinus bone, reshaping it, and then putting it back in a much flatter shape and secured with tiny titanium plates and screws. I have attached the ceph x-ray computer imaged as to how much flatter it can be.
The biggest issue for a male brow bone reduction is the scalp incision/scar required to do it. That often is the rate-limiting step for most men and is highly influenced by the man’s hair density and hairline pattern.
Dr. Barry Eppley
Q: I am an Asian American wanting to ask question to Dr. Eppley about a procedure. Is it possible to add material to the orbital rim to make it more deep? If so, what material and risks are involved?
A: When asking about building up the orbital rims, this is known as brow bone augmentation. By building out the brow bones, the globe or eyeball, will appear deeper. This is essentially a masculinizing procedure. Any of the cranioplasty materials can be used for brow bone augmentation and some plastic surgeons even use preformed or hand-carved synthetic implants. (which is not a technique that I use) The issue is not the type of material that can be used, since they all can work well, but the approach in which to do it. An incision is needed and the options include a scalp incision (for complete brow bone augmentation) or an upper eyelid incision. (for lateral brow bone augmentation) In a male with a high or variable hairline, a scalp incision is not usually cosmetically acceptable. This is less of an issue for a female.
Dr. Barry Eppley