Your Questions
Your Questions
Q: Dr. Eppley, we talked about1 month ago about forehead reduction. Subsequently I have gone to a hair transplant specialist where I live and he told me that he thought that I would not lose anymore hair in my life. Now this was of course only his assumption. Anyway, I’m really struggling with my forehead problem and it’s limiting my days and is taking a toll on my mind. I would like to know if it’s strictly not done on men or if this operation is only done on men at a certain age. And if I would actually lose my hair in the front in a couple of years, how big is the scar and is it very noticeable? Because I’m thinking about this operation all the time knowing that there is something that can be done. Thank you for your time.
A: It is not that it forehead reduction/contouring is never done in men because that is not true. It is just that one has to think about it much more carefully than a woman because of the hair issue. The forehead problem is men has to be more ‘significant’, in terms of either its shape or its psychological impact on the patient, to justify the effort and the scar risk. Scalp scars generally heal fairly well actually and usually end up as just a fine white line in most cases. Scars in hair tend to heal well provided the hair follicles are not damaged during the making or closing of the scalp incision.
Dr. Barry Eppley
Indianapolis Indiana
Q: I am interested in forehead augmentation to make the slope of my forehead less so and longer. I was hoping to retain my brow ridge prominence somewhat as that is a family trait…and in fact I’d like to keep the forehead looking sloped and straight as opposed to rounded and convex….keep it similar to how it is now, except for perhaps slightly raising the hair-line and moving it out a bit, while making the slope of the forehead greater, but certainly no where near convex. In other words, just as the brow ridges end moving toward the hair line, all of that forehead area I was hoping to making steeper, but still straight and non convex, and at the very top where the hair line is i was hoping to making higher and more in line with the rest of the forehead. Is that not possible? I don’t know how these surgeries work… in other words, I don’t know what the limitations are for the shape of the molds and their complexity…but I certainly didn’t want a drastic change in the forehead. How “complex” can the moulds be made that fit into the forehead region? What is the potential for tweaking certain aspects?
A: Forehead augmentation is not done by a preformed implant or a mold. It is done by cranioplasty onlay materials. These are mixed together at the time of surgery and applied like plaster of paris. It is then shaped by hand until the desired form is obtained and then allowed to set or cure. The average working time is about 10 minutes for this process. It is a very artistic technique which is why one has to have a very good idea what type of forehead shape the patient wants. You have been quite explicit as to your forehead shape desires which is good. Given the volume of material needed (at least 40 grams), PMMA (acrylic) is best for you because of the cost issue with that volume of material.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Hello. My hairline is kind of far back. I would say it is about 2 cm too far and it is really making me look odd. I have attached a video which captured it pretty good as well as some photographs. Here are my thoughts. Every cm. down would be a great thing for me, but as you can see, I also have some natural receded hair in the corners of each side. Could this look weird or odd in case of bringing the hairline down a bit or will they also be brought down? Also, I don’t mind the ehighht of my forehead. It is just that the hairline sits so far back.
A: When doing a hairline advancement, the entire frontal hairline is moved although the greatest movement is in the middle. Your issue for a forehead reduction is that you are a male and young. Since you can not possibly predict how stable your frontal hairline will be for the rest of your life, the fine line scar from the procedure along your existing hairline may not always be at the very edge of your hairline. This raises the very high probability for most men that the scar one day, sooner or later, may be visible in front of one’s hairline. This is why hairline advancements (forehead reductions) are rarely, if ever, done in men
Dr. Barry Eppley
Indianapolis Indiana
Q: I am looking to go about getting a procedure to make my forehead larger in height (length) and width and also to build around the temple area. But also my hairline is very low and am wondering if I get the forehead implants would I somehow be able to move my hairline up to show more of my forehead? After forehead implants what can be done about my hairline when getting this procedure.
A: Forehead augmentation, technically known as frontal cranioplasty, involves applying a moldable material to the forehead that then hardens fairly quickly. During the hardening process, it can be shaped in all dimensions including projection, width and height. These materials must be applied to bone and not soft tissue. Therefore, you can not widen the temple area as this is muscle not bone. The temple area requires a differernt material/implant approach.
With forehead augmentation, there may be some small vertical lengthening of the forehead when it is ‘expanded’ by augmentation. It may be in the range of 1/4 to 1/2 inch greater distance between the frontal hairline and the eyebrows. There is a limited amount of length increase that can be done. But this small increase, combined with greater forehead convexity, may make it appear slightly bigger than it really is. It may be possible to lengthen and stretch the forehead skin after augmentation through a coronal or scalp type of browlift technique but I doubt one would find that necessary later.
Dr. Barry Eppley
Indianapolis Indiana
Q: My forehead sticks out from the side is there anyway you could make it flat and look at least normal? I have attached s side view of my forehead so you can see how far it really sticks out.
A: Thank you for sending your picture. It does show a fair amount of convexity to your forehead. The amount of convexity could be reduced but it can not be made to be flat. The bone thickness will not support that much reduction.
Here is a computer image of what I think is the best that could be achieved with a burring reduction of the forehead bone. There is one way to know absolutely for sure how much reduction can be done and that is to get a simple lateral skull film x-ray. On that x-ray the thickness and, most importantly the thickness of the outer cranial table can be seen. The skull (forehead) is composed of three layers; an inner and outer hard cortical bone layer in between which exists a softer marrow diploic space. The amount of horizontal reduction of the forehead is limited by the thickness of the outer cranial table. It can only be reduced until one gets close to the diploic space. Measuring that on the x-ray could show how much the forehead could be reduced in thickness. A tracing of the before and after cranial contour could then show you the exact profile change that could be achieved.
Dr. Barry Eppley
Indianapolis Indiana
Q: I am wanting to get my forehead fixed. It just never grew in right and I have been made fun of since I was a kid. Photos may not look bad but I have been called horn head, hell boy, and square head all my life and I just want it to look a little better. I have two prominent ‘horns’ for lack of a better word on my forehead. I don’t know if these are just bone growths or my brain sticking out. They feel hard though. I have attached a picture so you can see them. Can these be burred down or something to make them look better?
A: Based on the one picture that I could see, it looks like you have two bulges on the sides of your forehead creating that look. These are very much like larger osteomas. The skull is thicker in these bulging areas. Reducing the bony bulges is actually fairly easy by burring them down to make the forehead less square and more round. The trick to it, however, is getting there to do it. The best approach would be a coronal (scalp) incision across the top of the scalp but that resultant scar (fine as it is) may not be a good choice for a male.The other approach is an endoscopic one where much smaller incisions are used. The access is not quite as good but I should still be able to burr down the prominent areas.
Indianapolis Indiana
Q: I am a bit disappointed with the way that I look and I would like to fix some things. I believe a forehead augmentation would help me look a lot better. One of the changes I would like my forehead to undergo is to put the hairline at a higehr height, so my foehead would become a bit higher. That means building up the upper forehead area about 1 to 2 cms. I don’t think it is necessary to build up any area of the parietal bone. These are the changes I desire in the hairy part of my forehead. The second change I desire is in the brow bone. I have the feeling that from the side, it doesn’t look masculine enough because the brow bone doesn’t stick out as it should in a male. I think an augmentation of a few millimeters and a reshaping with nice corners would improve the way my brow bone looks. The second change I would like to do is the slope of my forehead. The slope of my forehead is very good but somewhere between the hairline and the brow bone the frontal bone has a small ‘puddle’ and I think it should be built up too. Those are the changes I want to do for my forehead and I hope that an endoscopic bone augmenttaion would help. How many grams of cranioplasty material woould be used for this? I have attached a side view of my forehead for you to see its shape.
A: Thank you for sending your pictures. Despite the relative poor image quality, it is clear as to your forehead concerns. I think there is no doubt you would benefit by forehead augmentation (frontal cranioplasty) but I need to clarify what is and is not possible. To achieve a good result, your forehead augmentation can not be done closed or endoscopically.There is no way to ensure a smooth and confluent result by any type of injectable approach. Your forehead reshaping is too complex for that it would have to be done through an open approach requiring a scalp incision. Secondly, the volume of augmentation material that you require makes the use of Kryptonite too expensive. You likely require about 40 grams of material. Your most economic approach would be acrylic (PMMA) where such a volume of material is economically feasible. Thirdly, it is not possible to buildup your forehead as much as 2 cms, the scalp incision could not be closed afterward.
One cm. at most is what is possible. Lastly, your frontal hairline may come up a bit with the augmentation but not substantially so. It is not possible to buildup your forehead an surgically move your hairline back at the same time.
These are some practical considerations for you to consider.
Dr. Barry Eppley
Indianapolis Indiana
Q: I am interested in getting an endoscopic forehead augmentation done with the Kryptonite material. For the past few years from your website, I read that you believe endoscopic forehead augmentation leads often to a poor result. But since the Kryptonite material came out you sound more optimistic for the endoscopic forehead augmentation. Do you believe that this new material makes the endoscopic augmentation safer and widely useful for augmentation of larger areas of the forehead that before? Are complications possible?
A: With traditional cranioplasty materials, a true endoscopic or injectable forehead augmentation procedure is not really possible. The materials (acrylic and hydroxyapatite) are too thick and can not even be inserted through the small access provided by a few limited incisions. The emergence of Kryptonite cranioplasty material has made a small incision or injectable approach technically possible. Kryptonite has now made the procedure possible but it is not completely free of potential complications. The biggest issue with this injectable forehead cranioplasty is making sure the final result is smooth and confluent across the forehead. That is the trick to making this procedure truly successful and satisfying.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Doctor Eppley I am a 22 years old man who would like to undergo the forehead augmentation procedure for a small change in the shape of the forehead. I believe that I am a good candidate for an endoscopic forehead augmentation because the building of the forehead I desire is small. What procedure is right for me(endoscopic or coronal incision augmentation) is something you know better and you will decide when you will meet me in person. However I would like you to inform me about the endoscopic augmentation, about the cost and the position of the small incisions. The building up I desire is small and it is for a small area of the forehead. How much does it cost a traditional endoscopic forehead augmentation?
A: Thank you for your inquiry. One of the biggest drivers of the cost of endoscopic forehead augmentation is for the material, Kryptonite. Since you said the build-up is small, I will assume that you will need only 5 grams or less. That would put the cost right around $6500 to $ 7500. Like traditional endoscopic forehead surgery, two scalp incisions are used for making the dissection and placing the material. They are very small, being less than one inch each and are located behind the frontal hairline and to the sides if possible. Please send me pictures of your forehead concerns for my assessment and recommendations.
Dr. Barry Eppley
Indianapolis Indiana
Q: I am interested in making my forehead more vertical and round. I also want to have more height and width of the top of the skull. Do you think this is possible using the injectable Kryptonite method? I have attached some pictures for you to see the shape of my forehead. Let me know what you think.
A: Thank you for sending your pictures. I think I understand completely your forehead shaping objectives which would involve a cranioplasty fill of the forehead to make it more vertical from the brows up in profile (increased convexity) and to add width in the frontal view. This fill, in essence, is really to camouflage the slight brow bone prominence you have and will make the entire forehead more smooth and confluent. I have attached some imaging which is limited by the quality of the images you sent but I think it conveys the objectives.
In achieving this result, I do not think the injectable approach is best. It will take a prohibitive amount of material (cost wise) and the shaping must be perfect to have a happy end result. The evolution of the injectable cranioplasty approach is not quite far along in terms of experience to reliably give the best result for this more complex reshaping of a very visible facial area.Therefore, an open approach is best using PMMA (acrylic). That will allow an adequate amount of material to be used at a reasonable cost and get the best shape and smoothness of the forehead augmentation. The open cranioplasty approach in a male, however, is limited by the willingness of the patient to accept a scalp scar.
Dr. Barry Eppley
Indianapolis Indiana
Q: For my bulgy forehead, is it possible to burr down the forehead and then do a forehead/eyebrow lift at the same time, just removing the extra skin? The reason I ask is because my head is misshappen and my hairline is too high. I want my hairline to be lower so burring down some of the forehead and then making and eyebrow lift would help alot. After that is done I was going to get a hair transplant on my hairline to cover up the scar. Does this sound like it will work? Will it work if I get a hair transplant over the scar and can I do the eyebrow/forehead lift thing?
A: Your approach to a forehead or frontal contouring is conceptually correct. While I don’t know exactly where your exact hairline is now or what its shape is, making a scalp or coronal incision there allows one to access the forehead area. Probably about 5mms across the forehead bulge can be taken down. A browlift can then be performed and the redundant skin removed at the scalp incision line. This will shorten the perceived length or height of the forehead skin. Thereafter, no more than 3 to 6 months later, a hair transplant can then be done to put a camouflage to the scar. Such a scar in the scalp can often heal remarkably well due to the uniqueness of hair-bearing (or past hair-bearing) scalp skin.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I wrote you a couple of months ago about the possibility of undergoing a forehead contouring surgery to address my possible forehead bulging, to which you asked me to provide you with pictures. This is want I would like to do now and i have attached some forehead pictures for you to review. I don’t know whether the bulge is created by my high hairline or if it is just the way my forehead is. Basically, as previously stated, I would like to know if the problem is a high hairline or a protruding forehead, or both. At any rate, I would like to hear your surgical recommendations, or lack thereof!
A: Thank you for sending your pictures. I think there is some degree of a mild amount of forehead bulging that is accentuated by a higher hairline. Given the mild problem and the resultant scalp scar to improve it, I would not recommend any surgical modification. While it can certainly be done, the scalp scar in a male is a major limiting factor. This would not be such a rate-limiting step for surgical treatment in a female. I have looked at hundreds of male candidates over the years for cosmetic forehead contouring and brow bone reductions and could only ever justify surgery on about 2% to 3% of them.The magnitude of the forehead problem has to justify the trade-off of the scar to do it.
Indianapolis Indiana