Frontal bone reduction / brow bone reduction

Conveniently located to serve Washington DC, Arlington, Bethesda

The Forehead

A typical “feminine” forehead should be flat without any bone “bossing”, be shorter, have wider appearing orbits (eye sockets), eyebrows that are higher and more curved and a U shaped hairline.  A typical “masculine” forehead has an M shaped (widow’s peaking), a prominent frontal bone, lower and straighter eyebrows and a longer forehead.  To improve the appearance of the forehead, there are 2 options, depending on if scalp advancement is needed.

The Procedure

There are 2 ways to perform this procedure depending on whether hairline adjustment is needed. 

1. Forehead reduction with hairline advancement – used for patients who also need shortening of their forehead, elevation of their eyebrows and shaping their hairline.  This procedure is performed by making an incision at the junction of the hairbearing and non-hairbearing skin of the forehead.  The skin is lifted down to the eye level to expose the bone.  A high speed burr is used to shape the outside of the orbital bone to reduce the projection and create a wider, more shallow orbit.  The central area overlying the sinus is either reduced by just burring (type II forehead) or removing and shaping the bone and replacing it with small metal plates – frontal sinus setback (type III forehead).  We use X rays prior to surgery to evaluate the thickness of the bone to see which surgery is most appropriate.  Once the bone is flattened, the hair bearing scalp is elevated and advanced forward.  Some of the non-hair bearing skin is removed, which shortens the forehead, shapes the hairline and lifts the eyebrows.  The incision is closed and your head wrapped. 
2. Coronal incision – some patients may just require bony reduction, but no adjustment to their hairline, forehead or eyebrows or they may desire a less noticeable incision. In these cases, the incision is made at the top of the scalp in the hair bearing areas.  The skin is lifted and the bone reduced, but no skin is removed (doing so would lengthen the forehead by removing hair bearing skin).

Recovery

Recovery is fairly quick with sutures/staples being removed in 5-10 days. Swelling and bruising generally resolves in under 2 weeks and scar care is performed for a few months after surgery

Risks

1. Visible scars – with incisions made at the front of the hairline, there is a chance that the scars will be visible, especially with hairstyle techniques such as ponytails where the hair is pulled back.  If this is the case, we may recommend hair grafting to help hide the area. 
2. Sinus issues, uncommon, but there are cases when you could have sinusitis or blockage of the ducts
3. Contour issues – uncommon, but may require a minor revision.  In very thin skin patients, sometimes the plates can be felt through the skin
4. Nerve issues – numbness of the scalp generally resolves over time. There is a small chance of injury to the nerves to the forehead muscles
5. Eye injury – very rare, but due to the proximity to the eyes there is a very small chance
6. Hair loss – possible along the incision line