Background: The forehead represents one third of the face and had a valuable role to play in facial aesthetics. Besides the length and width of the forehead, its other major aesthetic feature is its slope. (as most easily appreciated in the side view) This forehead feature is well known to be gender specific. Women have more vertical inclined forehead (with convexity) and a smooth transition into the brow bones. Conversely men have a more inclined forehead with defined brow bones and a definitive break between the brow bones and the forehead.
Most men that desire forehead changes have issues with either the prominence of the brow bones or shape of the forehead above it. While both may be at fault, isolated forehead concerns are usually because of lack of projection. The forehead slopes back too far. The more retroclined the forehead slope is, the more unaesthetic it becomes as it creates more of a ‘neanderthal’ appearance by making the brow bones bigger.
Male forehead augmentation can be successfully done through two methods of bone augmentation. Options include the application of a bone cement (like PMMA) or the preoperative fabrication of a custom designed silicone implant. Each method has its own distinct advantages and disadvantages but both can be very effective. PMMA cement application requires an artistic sense to apply it evenly without over correction or palpable temporal edges.
Case Study: This 35 year-old male wanted to improve the shape of his forehead as he felt it had too much of a backward slope to it. It had a near 55 degree angulation and he wanted it almost vertical in a profile view.
Under general anesthesia, a limited coronal scalp incision was made without shaving any hair. A limited coronal incision means that it does not go all the way down to the ears but the incision stays 3 to 4 cms above it one each side. The forehead was exposed in the subperiosteal plane down to the brows inferiorly and to the temporal line at the sides. Using 60 grams of PMMA cement mixed with antibiotic powder, it was applied as a putty and shaped using the forehead/scalp flap to create the desired angulation and make it snooth. Once set the temporal and back edges were smoothed. The scalp incision was closed with dissolveable sutures with no use of a drain.
Recovery from the forehead augmentation was fairly quick with no bruising or significant eye swelling. The improvement in the slope of the forehead was noted immediately with full appreciation of the final effect by six weeks after surgery. Scalp numbness behind the incision line took over three months to return to normal. The final forehead contour was smooth with the exception of a small indentation behind the hairline on the left temporal side which was not a major concern to the patient.
The historic method of forehead augmentation with PMMA bone cement is still an effective treatment approach. Its biggest drawback is that it must be intraoperatively shaped and this introduces the variable of irregularities or shape issues. Considerable experience is needed in working with bone cements in their putty phase to master their handling and shaping.
1) Forehead augmentation in men is usually done to correct a severely backward sloping forehead which accentuates the size of the brow bones.
2) One method of forehead augmentation is the application of bone cement through an open scalp incision.
3) The shape of a male forehead augmentation is to change the slope of the forehead but to still preserve a brow bone break.
Dr. Barry Eppley