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Forehead bone/ brow ridge contouring surgery
The shape of skull in a male and a female is quite different in nature. Male forehead has extensive brow bossing (supraorbital bossing) with a flat area above the bossing, while female's tends to have a completely convex skull in all planes and the supraorbital bossing in female is considerably less or almost absence.
Comparing the degree of deformity and treatment necessary to correct the corresponding deformity, the various forehead contours have been divided into three groups.
Group 1 includes those patients with slightly anterior projection of the supraorbital rims, minimal to moderate bossing and thick skull bone over the frontal sinus and/or absence of the frontal sinus. These deformities can be corrected by bone reduction alone utilizing a surgical burr.
Group 2 includes those individuals with slightly anterior projection of the supraorbital rims but in whom the frontal bossing is combined with relatively thin bone over the frontal sinuses, the sinuses being of normal size. Correction requires completing as much contouring of the bones as possible without entering the sinus.
Group 3 includes those patients in whom the anterior projection of the supraorbital rims is so excessive that adequate bone reduction contouring is impossible without entering the frontal sinus. In these individuals, the frontal sinus must be opened through a sinus osteotomy and the entire anterior sinus wall and associated supraorbital rim set back and fixed into position by using wires or micro-titanium plates and screws.
The use of methyl methacrylate (bone cement) and/or synthetic material like Gore-tex may be required for group 3 patients to achieve a very smooth contour of forehead.
For those whose upper forehead is receded, it is also possible to use methyl methacrylate for forehead augmentation as an additional procedure.
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Surgical technique
In virtually all procedures for aesthetic skeletal contouing, general anesthesia is used.
All procedures involve a bicoronal incision placed either in the scalp (6-8cm behind the hairline) or at the hairline (if done in conjuction with forhead/brow lift).
Hair is not shaved. In preparation for the surgery, the hair is tied back with rubber bands in front of and behind the incision area.
The incision is made with a surgical blade, beveling appropriately so as to avoid as many hair follicles as possible.
The scalp is elevated in a plane superficial to the periosteum anteriorly and the subperiosteal plane is entered at the level of hairline down to the level of supra orbital ridge.
The supra trochlear and supraorbital nerves and vessels is identified and well protected during the dissection of periosteum over the orbital rims.
The amount of bone removal/ alternation will depend on the anatomy of forehead bone/ sinus described above.
After completion of the contouring procedures, the wound is closed by repositioning of the soft tissue layer by layer and skin is joined meticulously with fine suture (no stapples used).The total time of the procedure lasts 2-3 hours
The bandage and/or facial pressure garment is neccessary for 1-2 weeks during the healing process.
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Skull x-ray study for type 3 forehead: case 1 |
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Description of the x-ray finding:
This is a classical type 3 forehead, the frontal sinus is very large and its anterior wall is very thin. |
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Skull x-ray study for type 3 forehead: case 2 |
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Description of the x-ray finding:
This is a variant type 3 forehead, thin anterior wall but the size of sinus is quite small. |
(2006-7 © Dr.Chettawut Tulayaphanich; All rights reserved)
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