Global Courant
The need to change the shape of the forehead or brow bone is very unusual. Reshaping the forehead or brow bone (the bone below the eyebrows) is possible, but there are different procedures that can be performed based on the shape of the forehead and brow bone.
The shape of the skull between a male and a female is often quite different. The male forehead often has fullness over the brow bone known as brow tufts or a supraorbital protrusion with a flatter brow above this area. In contrast, the female forehead has a more convex or arched forehead shape and little or no significant supraorbital bulge. Such forehead shapes give a masculine or a feminine appearance.
The degree of arching of the eyebrows and the shape of the forehead help determine the type of surgical recontouring to be performed. With the exception of one other important consideration… the frontal sinus. The frontal sinus, an air-filled bone cavity, sits right under the brow bone and how developed it is will influence surgical choices. For this reason, all surgical procedures when adjusting the forehead/eyebrow should have a simple X-ray of the skull (lateral view) prior to surgery.
In those patients with mild to moderate brow bulge and thick cranial bone over the frontal sinus (or missing a frontal sinus), bone reduction by burrs can be done with good results. When there is bulging eyebrows, but the bone thickness above the frontal sinus is thin, simple bone reduction is impossible without entering the frontal sinus. Many try just a little bit of bone reduction, without entering the sinus, but it doesn’t make enough of a difference to warrant the effort. Removing just 1 or 2 mm of bone is not enough to make a difference. In this situation, an option is to open the frontal sinus, deburr the edges of the bone, and replace the ‘outer lid’ in a more inward contour, preserving the frontal sinus. The other option is to erase the sinus and fill it with a bone substitute material, creating a flatter brow contour with the bone paste or cement. (and don’t put back the bone outer table) I’ve done both and both will work. If I can get a good brow contour and keep the frontal sinus still present and functioning, that’s my preference.
Forehead and eyebrow contouring requires an open approach through an incision in the scalp or hairline. The skin of the forehead must be ‘peeled off’ to allow proper access for surgery. An endoscopic approach or a narrower approach is not enough to do a good job. In most women, the hairline and hair density patterns allow for an open approach. When considering this procedure in men, the hair problem may make an open scalp approach more problematic.
The most common patient, in my experience, for brow bone reduction is in female feminization surgery (FFS), where reducing the prominence of the brow bone helps with the overall facial conversion from the male to female appearance. In a few select males with very prominent brow bones, this procedure can make a big difference in softening the more ‘neanderthal’ facial appearance.
Reshaping the prominent brow bone with plastic surgery
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