How Can I Fix My Brow Bone Irregularities After Two Prior Forehead Feminization Surgeries?

Q: Dr. Eppley, I have had two previous reconstructive surgeries on my forehead. Originally a feminisation surgery was performed which went poorly, using an unusual technique of essentially recreating the conditions of a frontal sinus fracture and suturing it all back together. Following that surgery I had a revision with another surgeon to try to correct that defect and finish the feminization work using a type 3 approach. Unfortunately whilst the revision went well I still have a depression/defect from the original surgery which seems to be presenting with a loss of volume around the inner eye causing skin laxity and some concern to me long-term. I’m curious what approach you might suggest in addressing this given the proximity to the nerves in this area and my having fairly thin skin. I am fairly recently post surgery so I’m really just trying to understand better at this point.

I have attached some 3d images of the CT scans taken at each stage. Hopefully the issue is clear enough.

A: If the issue is a loss of brow bone contour (indented and not smooth) I would use hydroxyapatite cement to fill it in and smooth it over. This would be the most appropriate contouring material for the frontal sinus area as well as the most assured method of a completely smooth contour with seamless edging. It would only take about 5 grams of material to do so.

Dr. Barry Eppley

World-Renowned Plastic Surgeon