Your Questions

Q: Dr. Eppley,  I had my forehead and brow bone augmentation for correction of a frontal sinus and forehead depression from an old injury done three weeks ago. I have a few question about my result. The stitches on my eye seems to have a permanent crease. Is it gonna get straight and flatten out later? Also the operated side of my head is more elevated. You informed me that it would nearly perfect before we started this operation. I’ve waited nearly 10 year before I had the funds to do this operation and I really want it to be perfect.

A: Good to hear from you and thanks for the followup. Before answering your specific questions, let me refresh your memory as to our preoperative discussion. If we wanted the perfect result and the most assured way to achieve that, the operation would have been done from a large scalp incision from above where everything can be seen from the normal side to the depressed side. We chose not to pursue that option for the obvious negative tradeoff of a large unaesthetic scalp scar. In choosing to go through the eyelid with more limited visibility, which is the right choice and one I would repeat, the contour may be less than perfect and the potential risk of revisional surgery is higher. That is the potential aesthetic trade-off for that approach.

In specific answer to your questions:

1) The eyelid incision/scar, particularly in Asian skin, takes a long time to settle down and mature. Asian skin is particularly  prone to early scar hypertrophy and hyperpigmentation. It will take at least 6 months before you will see what the final scar outcome will be.

2) The final shape of the forehead and brow augmentation will take at least three months for all swelling to go away and an additional 3 months for the scalp tissues to shrink down and contract around the implant. This will be particularly true in your case because of the hematoma and second operation you sustained. At just one month after surgery, it is simply too early to say what the final result will be. I would much rather see a contour that is too big at this point as it has the potential to go down…rather than too small of a result which has no chance to improve with time.

In conclusion, it is too early to judge the result. Patience is the key and a more useful assessment will be at three months after surgery. No consideration will be given for any form of revisional surgery (not that I am antipating or hoping for it) until six months after the original procedure.

Dr. Barry Eppley

Indianapolis, Indiana