Frontal Bone Contouring Surgery

 

659. <Frontal Bone Contouring Surgery>

Frontal bone contouring surgery is performed when the forehead is excessively protruding, too flat, or sunken; to correct deformities following trauma or brain surgery; or during gender transition—such as reducing or pushing in prominent brow ridges when transitioning from male to female, or augmenting the brow area when transitioning from female to male. This surgery redefines the contour of the forehead.

First, frontal bone reduction surgery involves exposing the forehead bone via a coronal incision through the scalp. The thickness of the frontal bone, previously measured with a facial CT scan, guides the shaving down of protruding areas. If the brow bone is also protruding, it can be shaved or pushed inward. When the brow bone is thicker than the frontal sinus as seen on CT, it can be shaved down. In cases where only the brow bone needs reduction—known as brow bone shaving surgery—a coronal incision is unnecessary; instead, a sub-brow incision can expose and allow shaving of the brow bone. For patients planning to undergo double eyelid surgery, the brow bone can be shaved through the eyelid incision line.

When the brow bone is thin, with minimal bone to shave, and the frontal sinus is well-developed, it is not shaved but pushed inward—this is referred to as brow bone reduction surgery. This procedure involves peeling back the forehead skin via a coronal incision, observing the brow bone directly, and performing osteotomy to push it in. To prevent frontal sinusitis, it's best to preserve the mucosa of the frontal sinus. Additionally, the outer parts of the brow bone can be shaved to address bulging upper eyelids.

Frontal bone augmentation surgery is suitable for individuals with sunken or flat foreheads. Using artificial bones or silicone increases the risk of infection. Recently, 3D-printed custom implants have allowed for more precise shaping to the patient’s preference, but since they are still artificial materials, the risk of inflammation remains. Using autologous tissue is a way to reduce inflammation risks. Options include autologous bone graft and autologous fat graft.

When performing an autologous bone graft to the forehead, bone removed during other facial contouring surgeries—such as jaw or cheekbone reduction—can be ground and particleized, then grafted to the forehead to add volume. Therefore, autologous bone grafting is recommended for patients already undergoing facial bone reduction, rather than harvesting bone from the skull or iliac crest unnecessarily. For those not undergoing facial bone procedures, fat grafting can be used to shape the forehead.

Forehead asymmetry can result from past injuries or from asymmetrical brow bones, making the forehead appear uneven. In cases of brow bone asymmetry, the bones can be asymmetrically pushed in or shaved to improve balance. If necessary, the final adjustments can be made using fat grafting.

Thus, forehead bone can be shaved or filled, and brow bones can be shaved, pushed in, or augmented to improve the shape of the forehead. If the asymmetry or depression is due to a past fracture, particulate bone grafting or fat grafting can help restore the contour. However, since the frontal sinus plays a role in ventilating the heat from the frontal lobe, special care must be taken during frontal bone contouring surgery to avoid compromising it.

[Frontal bone contouring surgery is a procedure that improves the contour lines of the upper facial area.]
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