Where Is The Scar Placed For Brow Bone Reduction Surgery?
Q: Dr. Eppley, I am interested in brow bone reduction surgery. I am a 37 year old transgender. I started transition about eight years ago. I still need to have my browbone shaved and lifted a little. I’m just scared of side effects like big scars in the hairline and permanent numbness. Is the scar hidden in the hair ? Please advise. And how long before I can get back to my normal activities?
A: When it comes to brow bone reduction, there are two basic incisional approaches to it. The incision could be placed either at the frontal hairline or back further in the scalp. There are advantages and disadvantages to either incisional approach depending upon other features of the brow, forehead and frontal hairline. If one is happy with their current brow position, has a low to average forehead height (brow to hairline distance) and has any type of frontal hairline density, then the coronal (way back in the hairline) incision can be used to avoid any risk of frontal hairline scarring. But there will be a longer scar across the scalp and a greater risk of some reduced scalp sensation permanently. The frontal hairline (pretrichial) incision can be used when the brows need to lifted, there is an average to long forehead length (usually greater than 6 to 6.5 cms) and one wants to either maintain their existing forehead length or advance or lower the frontal hairline to to shorten their forehead height. The pretrichial incisional length would be shorter than the coronal incision (because it it closer to the brow) and there is less risk of any significant scalp numbness.
The scars from either the coronal or pretrichial incision usually heal well as evidenced on my experience of very few scalp/hairline scar revision ever requested. Quite surprisingly, even though the frontal hairline incision is more ‘exposed’, it actually heals very well as hair eventually grows through it. As a result, many brow bone reduction particularly in the transgender patients, use a pretrichial incision. This is also useful as hairline advancements, brow lifts and upper forehead augmentations (to create greater forehead convexity) are often aesthetically advantageous and simultaneously done.
Recovery from brow bone reductions is very similar to that of an open brow lift. It is all about how much swelling one gets around the eyes and how long it takes to go away until looks socially acceptable. That is usually about ten days.
Dr. Barry Eppley