How Can My HA Bone Cement Forehead Augmentation Be Reshaped?

Q: Dr. Eppley, I had facial feminization surgery about two years ago. That included placement of hydroxyapatite bone cement in the forehead, but I ended up with a visibly raised area running along the central part of my forehead, above my eyebrows. I know there are surgeons who shave brow bones endoscopically. Is it possible to contour bone cement endoscopically?

Of possible significance is that the surgeon shaved down the bone above the frontal sinus too aggressively, and there’s now a small hole there. I’m not looking to get the glabella area revised, just the areas above and to the sides.

A:  I suspect you had HA bone cement placed in the central/upper forehead as a contouring technique to complement the brow bone reduction…this is a not uncommon technique. But it is a very sensitive onlay bone augmentation technique that is unforgiving in the shape/amount of augmentation as well as edge transition.

While HA material can be removed endoscopically in its entirely it can only be contoured/reshaped by the original method by which it was placed. (open approach) HA is essentially a ceramic material so it is very brittle and easily fractures so remote attempts at trying to reshape it is prone to secondary contour problems.

Dr. Barry Eppley

World Renowned Plastic Surgeon