Brow bossing and upper frontal prominence, what would be a better option burring or surgery?

I use both endoscopic and open techniques to treat bony forehead contour irregularities, and the most important step is deciding which method is right for each lesion.  Endoscopic burring can be used to reduce very small bone irregularities, but is typically not the best way to treat brow bossing.  The bossing is usually caused by the presence of the frontal sinus, an air-filled cavity in the bone just under the bulge, and the bone over the sinus is normally quite thin.  If you try to burr down the area of bossing for the average patient you will open up sinus and have a hole in the bone that your brow will collapse into.  For brow bossing the best treatment is almost always removing the front wall of the sinus, reducing, and then reattaching it.  Small bony bumps in the mid to upper forehead are best treated with endoscopic (arthroscopic is endoscopic surgery in a joint like the knee or shoulder) burring.  Find a surgeon who does both procedures and they will be able to tell you which would best address your concerns.  -Dr. Rolfes

Thank you for your question. The prominent brow bone is a common problem that we treat and you don't have to be a transgender patient to need this. There are multiple opinions out there on what to do. Burring the bone is tricky and depending on the thickness of the bone and the degree of prominence, burring may lead to a bone defect or 'hole' which is a bad outcome. Setting the bone back is a good option, and I know it sounds like an invasive procedure. It is frustrating to spend money and still have no decision. You can come in for complimentary consultation if you would like and we will give you all the information you would need and determine what will work best for you

I need to see pictures but I've reduced the excess frontal bone on both male and female patients that are not transgender. This can be done using either the arthroscopic or open techniques depending on each patient's needs. Augmenting any depressions is also another option in  some patients to improve contour if the bone is very thin.