Your Questions
Your Questions
Q: Dr. Eppley, I am interested in a forehead reduction. I have attached two photos of my forehead for your review. I hope these are enough. As you can see my forehead is massive and it gets me down !! Can you help? Is it always successful? Is there much recovery?
A: Thank you for sending your pictures. What you refer to as a massive forehead is one that is very long. I would estimate that the measurement between your eyebrows and the edge of your frontal hairline is at least 7.5 cms. If the forehead length in females is greater than 6.5 cms it is considered too long. This can be improved with a frontal hairline advancement, also known as a forehead reduction. This is where an incision is placed along the edge of the frontal hairline, the scalp behind it is loosened, lifted and brought forward, and the forehead skin underneath then removed. The amount of forehead skin removed is the amount that the vertical length of the forehead is shortened. Generally, 1.0 to 1.5 cms can be reduced in the middle of the forehead. There is less so taken out from the sides where it tapers into the upper temporal area. This is a very effective and successful procedure. Forehead reduction is an outpatient procedure that takes 90 minutes to do under general anesthesia.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a question about the postop healing process for a forehead reduction/hairline advancement. It has been just about 2 months since my surgery and my scalp is still not healed. I have some large areas of scabbing over the incision sites and don’t know but it seems like they should be healed by now. I don’t know if I am doing something or taking some medication that would slow this healing process. Please just let me know if this is normal I can also send you some pictures if you would like.
A: It is certainly not common to have a forehead incision that is not completely healed after two months. The scalp is such a well vascularized tissue that it is hard for any portion of it to not heal unless there is a good reason. Most likely, these non-healing areas represent spitting sutures. If you look close at them after removing the scabs, you may see little white threads which are dissolveable sutures sticking out. Many times along the hairline the body will spit them out long before they will ever dissolve. There presence at the incision lines now serves as a chronic source of infection which appears like a pimple or small draining sinus. This is a common problem in many body areas and the hairline is no exception. If you can pick out those white sutures you will remove the source of irritation and the areas will go on to complete healing. I have seen this wound occurrence many times after pretrichial browlifts and forehead reductions.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I don’t like having a large forehead. I would like it reduced by at least an inch. I understand by having the eyes done that will also can help. I also hate how one eye brow is lower than the other one. I am sending pictures from the front and side views so you can what I mean.
A: Thank you for sending your pictures. I can see the three issues of concern, your very long forehead, eyebrow asymmetry and extra skin on the upper eyelids. Most frontal hairlines (forehead reductions) can be advanced close to an inch, depending upon how mobile one’s scalp is after it is freed up. The advancement is always greatest in the middle and tapers out towards the temporal hairline. To improve your eyebrow asymmetry, more skin would be taken out on the left side than the right as it tapers outward. The upper and lower blepharoplasties would be done in the conventional fashion with skin and fat removal. The combination of all three would make for quite a periorbital and forehead rejuvenation effect.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Hello. My hairline is kind of far back. I would say it is about 2 cm too far and it is really making me look odd. I have attached a video which captured it pretty good as well as some photographs. Here are my thoughts. Every cm. down would be a great thing for me, but as you can see, I also have some natural receded hair in the corners of each side. Could this look weird or odd in case of bringing the hairline down a bit or will they also be brought down? Also, I don’t mind the ehighht of my forehead. It is just that the hairline sits so far back.
A: When doing a hairline advancement, the entire frontal hairline is moved although the greatest movement is in the middle. Your issue for a forehead reduction is that you are a male and young. Since you can not possibly predict how stable your frontal hairline will be for the rest of your life, the fine line scar from the procedure along your existing hairline may not always be at the very edge of your hairline. This raises the very high probability for most men that the scar one day, sooner or later, may be visible in front of one’s hairline. This is why hairline advancements (forehead reductions) are rarely, if ever, done in men
Dr. Barry Eppley
Indianapolis Indiana
Q: My forehead sticks out from the side is there anyway you could make it flat and look at least normal? I have attached s side view of my forehead so you can see how far it really sticks out.
A: Thank you for sending your picture. It does show a fair amount of convexity to your forehead. The amount of convexity could be reduced but it can not be made to be flat. The bone thickness will not support that much reduction.
Here is a computer image of what I think is the best that could be achieved with a burring reduction of the forehead bone. There is one way to know absolutely for sure how much reduction can be done and that is to get a simple lateral skull film x-ray. On that x-ray the thickness and, most importantly the thickness of the outer cranial table can be seen. The skull (forehead) is composed of three layers; an inner and outer hard cortical bone layer in between which exists a softer marrow diploic space. The amount of horizontal reduction of the forehead is limited by the thickness of the outer cranial table. It can only be reduced until one gets close to the diploic space. Measuring that on the x-ray could show how much the forehead could be reduced in thickness. A tracing of the before and after cranial contour could then show you the exact profile change that could be achieved.
Dr. Barry Eppley
Indianapolis Indiana
Q: I am wanting to get my forehead fixed. It just never grew in right and I have been made fun of since I was a kid. Photos may not look bad but I have been called horn head, hell boy, and square head all my life and I just want it to look a little better. I have two prominent ‘horns’ for lack of a better word on my forehead. I don’t know if these are just bone growths or my brain sticking out. They feel hard though. I have attached a picture so you can see them. Can these be burred down or something to make them look better?
A: Based on the one picture that I could see, it looks like you have two bulges on the sides of your forehead creating that look. These are very much like larger osteomas. The skull is thicker in these bulging areas. Reducing the bony bulges is actually fairly easy by burring them down to make the forehead less square and more round. The trick to it, however, is getting there to do it. The best approach would be a coronal (scalp) incision across the top of the scalp but that resultant scar (fine as it is) may not be a good choice for a male.The other approach is an endoscopic one where much smaller incisions are used. The access is not quite as good but I should still be able to burr down the prominent areas.
Indianapolis Indiana
Q:I would like to ask you some advise. I have a high natural hairline that makes my forehead look bigger. I don’t have problem of losing hair. I would like to have a hairline lowering, but I don’t know how to choose between a forehead reduction and a hair transplant. With the forehead reduction I will have a quick result and after seeing some pictures on internet the result looks great. The bad point is the scar and I would like to know if this procedure can have a bad consequence for the future. For the hair transplant I would like to know if the result can be natural, I have long and dense hair. I have attached some pictures for you to see.
A: Thank you for sending your pictures. I don’t know if that is the standard way you wear your hair or whether you were doing that just for the pictures. (I’ll assume you were doing that just for the pictures) You have a very good hair density and a relatively full hairline pattern. I really think you could go either way with a hairline advancement or hair transplants. each has their own advantages and disadvantages for you. Hair transplants will have no hairline scar but I doubt you can get the density of your natural hair down to 2 cms from your existing hairline. You certainly won’t be able to do it in one session. If for whatever reason you don’t like the transplants then that effort will be wasted by doing a hairline advancement after. With the hairline advancement, you will get a well matched hairline density and pattern but at the expense of a very fine line scar.
My thoughts are that the hairline advancement is the best initial approach. Because…if the scar is too prominent it can be easily covered up with some hair transplants later. The reverse is definitely not true.
Dr. Barry Eppley
Indianapolis Indiana
Q: For my bulgy forehead, is it possible to burr down the forehead and then do a forehead/eyebrow lift at the same time, just removing the extra skin? The reason I ask is because my head is misshappen and my hairline is too high. I want my hairline to be lower so burring down some of the forehead and then making and eyebrow lift would help alot. After that is done I was going to get a hair transplant on my hairline to cover up the scar. Does this sound like it will work? Will it work if I get a hair transplant over the scar and can I do the eyebrow/forehead lift thing?
A: Your approach to a forehead or frontal contouring is conceptually correct. While I don’t know exactly where your exact hairline is now or what its shape is, making a scalp or coronal incision there allows one to access the forehead area. Probably about 5mms across the forehead bulge can be taken down. A browlift can then be performed and the redundant skin removed at the scalp incision line. This will shorten the perceived length or height of the forehead skin. Thereafter, no more than 3 to 6 months later, a hair transplant can then be done to put a camouflage to the scar. Such a scar in the scalp can often heal remarkably well due to the uniqueness of hair-bearing (or past hair-bearing) scalp skin.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Hi. i am an 18 year old male who is looking at getting something done to flatten my forehead and reduce my brow ridge, as I am unhappy with how it looks. i just wanted to know if I am a bit young to be getting something like this done? Also I play a fair bit of soccer so would like to know if it would affect how I header the ball permanently if I was to get surgery like this? Also would the scarring be noticable if it were not on the hairline?
A: From your description, it appears that one side of your forehead is more protrusive than the other, giving you forehead and brow asymmetry. The surgical technique for brow reduction is more effective than forehead reduction. The middle and tail of the brow bone (which is usually the most noticeable) can be burred down fairly significantly. The forehead bone that extends above it, however, can not be so significantly reduced. The outer table of the forehead bone (cranium) is only about 5mms or so thick before the diploic space is entered. From a practical standpoint, you don’t want to be reducing the bone into the diploic space so only about 4mms or so of bone can be reduced. While this would make some difference, the brow reduction and shaping would be more significant. The other important issue is that to do the forehead reduction, a large coronal scalp incision would be needed. This creates it own aesthetic issues and the trade-off of the scar for the amount of forehead reduction may not be a good one.
Doing the brow bone reduction, however, can be done through an upper eyelid incision. Given this hidden scar and for the amount of brow improvement, this would be a much better trade-off.
Indianapolis, Indiana
Q: Hi doctor, I have a big forehead and I need a scalp advancement to make it smaller. To do this surgery do you needs to shave my hair? What is the maximum of centimeters that you can reduce? How much does this surgery cost? Thank you.
A: A long forehead can be reduced by moving the scalp forward (hairline advancement) and removing upper forehead non-hairbearing skin. While this does leave a fine line scar along the frontal hairline, that is usually nto a problem for most women. As long as the hairline is distinct with reasonable density, the scar is usually a good trade-off. One of the keys to a scalp advancement is to secure it to the underlying frontal bone in its new position. This will not only prevent relapse but will also take the tension off of the scarline so it heals as narrow as possible.
In answer to your specific questions:
1) No hair is ever shaved for the procedure.
2) Usually at least 2 to 2.5 cms of scalp can be advanced with the same vertical reduction in forehead skin. That tapers off into the temple areas. The greatest amount of advancement is in the center.
3) The overall costs are about $ 7500 – $ 8500
For those women afflicted with a very high hairline, a forehead reduction procedure through a scalpadvancement can be life-changing. One can think of it as a ‘reverse browlift’ so it is an outpatient procedure that takes about 2 hours to perform. The very next day one can wash and style their hair.
Indianapolis, Indiana
Q : Hi Dr Eppley, I am inquiring about how to reduce a long forehead. My forehead is so long it is ridiculous. I have good hair but my hairline is so far back I can’t wear my hair pulled back. My forehead also has a bulge in it near the hairline which makes it look like it is even back further. I have heard that a plastic surgery procedure exists that can pull my hairline forward. Is this possible?
A: The typical distance for most people between their eyebrows and their hairline (forehead length) is up to 7 cms. When that distance is greater than that, most people would consider it to be a long forehead. In actuality, however, if one thinks that they have too much forehead skin then they do.
One’s forehead can be shortened through a skin excision procedure. The skin is removed in front of the hairline and the scalp hair brought forward in its place. In essence, this is a reverse browlift. The amount of scalp advancement can be up to 2 cms to 2.5 cms without any problem. More can sometimes be obtained by a very posterior scalp elevation at the subgaleal level the whole back to the occiput. Even more than that can be obtained by a two-stage procedure using a tissue expander although this is reserved only for the most severe cases.
The trade-off for a forehead reduction is a fine line scar along the hairline. As long as one has reasonable hair density and hair quality this is not a concern. With the forehead bone exposed, any bony contouring or reduction can be done at the same time.
Dr. Barry Eppley
Q: I am interested in forehead reshaping. I have a very large forehead which I know takes away from my appearance and I’ve been teased about it alot. How is this procedure done?
A: The forehead makes up one-third of the total face and is frequently overlooked as having a major contribution to one’s appearance. Only when something about the forehead is ‘wrong’ does one take notice of its facial significance.
When a patient feels that they have a forehead problem, they are usually referring to two potential concerns or problems. The issues are usually its shape, which is a reflection of the underlying shape of the bone, or of its length or height, which is a the result of the amount of skin between the frontal hairline and the brows.
Forehead bone problems could be irregularities, bumps or high spots, prominent brow bones, or the narrowness or width of the forehead from one temple to the other. Such forehead problems are treated with frontal cranioplasty procedures where the bone can be reduced or added by different materials. This does require an open approach with a scalp scar needed for access. But with this wide open visibility, a wide array of bone reshaping and contouring can be relatively easily done to the frontal and brow bones.
Too high a forehead or too long of a forehead is a matter of skin reduction. This procedure is essentially a ‘reverse browlift’ where the skin is removed through an incision at the frontal hairline. Instead of the brows coming up, the frontal hairline comes down thus shortening the visible forehead skin to 7cms or less in vertical length.
Dr. Barry Eppley
