Brow Bone Reduction or Forehead Augmentation Above Brow Bone?

Question

I'm a 20 year old male and want to improve my forehead and nose. I have a prominent brow bone which kind of gives me that "neanderthal" look. Would a brow bone reduction be the best option or would another form of forehead recontouring, such as an implant above the brow bone area, work best? As for my nose, I don't like how it projects too far out, too much nostril shows and I have a bulbus-ish tip. I also have thick skin. Would it be possible to make my nose "flatter" and have a refined tip?

Sirius K. Yoo, MD · Answer

Hi, there. Thanks for posting this question!

	As you mentioned, a prominent brow bone can contribute to a “Neanderthal” look. However, a forehead that slopes back may play a role, too.

	The goal of “forehead recontouring” is to bring the upper third of the face in harmony with the lower two-thirds by reshaping the underlying frontal structures. There are two possible procedures: brow contouring and/or frontal augmentation. Brow contouring addresses a prominent brow bone and involves shaving down the brow bone to produce a less-prominent appearance.  Frontal augmentation addresses a backward-sloping forehead and my preferred approach is to inject a bone filler on top of the frontal bone to bring the area above the brow “forward.”

	One or both of these two operations may be necessary to achieve your desired look. It is difficult to know without examining your unique facial structure.

	There are a few different surgical approaches to brow contouring and frontal augmentation. If you have a very high hairline, then perhaps a coronal approach is best (but not necessarily).  On the other hand, if you have a normal or low hairline, then I find that endoscopic techniques offer the best patient satisfaction (diminished pain and better scar). 

	For brow contouring, I will usually make the entry incision slightly larger to accommodate the larger caliber of the drill.  For frontal augmentation, I prefer to inject alloplastic bone filler through a small endoscopic incision behind the hairline using a straw-like "cannula."  The filler is initially like a paste that can be molded for several minutes before it solidifies.
	For brow contouring, a preoperative CT scan may be necessary depending on the amount of bone that would be optimal to remove.  The frontal sinuses often lie directly behind the brow bone and should not be penetrated during surgery.

	Rhinoplasty (nose surgery) is also very individualized.  Every concern you expressed in your question is reasonable and generally possible.  Thick skin definitely diminishes the amount of "refinement" that you can expect, but improvement is almost always possible.

	As always, a face-to-face consult would be very beneficial.  A well-trained surgeon should be able to guide you through the process.  Choose someone you connect and feel comfortable with before moving forward.  Never shy away from getting a second opinion if you have any reservations.

Toby Mayer, MD · Answer

Boney orbital contouring can be done thru an Irregular Trichophytic incision. Hair grows thru the scar and not behind it so you do not need a bicoronal incision. The nasal issues you mentioned can be done at the same time. Examples of both are on my website.

Samir Shureih, MD · Answer

To contour the forehead and get rid of the frontal bossing, one need a full evaluation and an x-ray to evaluate the bone thickness and the frontal sinus underneath. The bone can be shaved. One needs a full exposure with incision from ear to ear, the traditional bicoronal incision to expose the four nerves in the area and avoid them then avoid entering the frontal sinus.

	Sometimes one needs to use an acellular graft to further soften the forehead.

	As for the nose need full evaluation and exam to advise you

Brow Bone Reduction or Forehead Augmentation Above Brow Bone?

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