Can Brow Bone Augmentation Be Done By Custom Implants?

Q: Dr. Eppley, I would like information about brow bone augmentation with calcium hydroxyapatite and customized implants from 3D CT scans. I had a rhinoplasty where the surgeon used transverse and medial osteotomies of the nasal pyramid, and nasal dorsum. I realized that the eyebrows lost support after surgery. The augmentation surgery in the region of the supra-orbital rim or brow ridges with customized implants are made of what material?

A: Brow bone augmentation can be done by different materials which can also control the surgical approach to place them. (incisional access) The traditional and still most commonly performed technique for brow bone augmentation is through an open scalp incision using either PMMA or hydroxyapatite bone cements. When just the brow bone is being done, hydroxyapatite cement is the material of choice. But when the brow bone is being combined with total forehead augmentation, PMMA bone cement is used due to being a more lower cost material per amount of volume. Performed or custom implants can also obviously be placed through such a wide open exposure. Custom brow bone implants made from a 3D CT scan are always made of a silicone material, primarily due to ease of adaptation to the underlying brow bone and cost. Newer techniques of placing custom or preformed silicone brow bone implants are being developed to avoid the larger scalp incision. (endoscopic frontal and upper eyelid incision)