What Is The Best Way To Restore My Masculine Appearance After Brow Bone Reduction Surgery?

Q: Dr. Eppley, I had a brow bone reduction surgery in 2014 which has had a few problems since then. Not sure if it was a type I or III. The goal was NOT to feminize my face. I have provided a pic of my brow bone before the surgery at age 35. I had a Liam Neeson brow. I have a depression at the top center incision line and also what appears to be grooves or cracks. I would need to have an open incision from ear to ear again, but the only way to resolve this.

My goals are to improve a more smoother more symmetrical MASCULINE even surface forehead from left to right

1.) take bone fragments pieces from top incision line indentation; reinsert them (bone grafting of my own bone material) to smooth out even to achieve a uniform contour.

2.) bone grafting of extended curved fractures from lower middle of forehead to arched upper outer forehead

3.) smooth out small bump on middle of far left forehead

4.) discuss right orbital add bone grafting technique to upper inner corner only (bone paste or bone cement, human tissue glue or donor bone from rib or hip) My left orbital rim is masculine, please do not change at all. My right orbital rim is feminine. This is due to a childhood trauma injury.

5.) may discuss adding a little bone grafting material to middle (between eyebrows) for a more masculine appearance

These ideas I would like an opportunity to discuss with you to consider your best practice approach and of your recommendations.

A: A needed 3D Ct scan scan will certainly show the bony contours/irregularities/defects that have resulted from a prior brow bone setback surgery. And while knowing those details are important, and all will be seen in surgery once exposed, the fundamental reconstruction decision is how to recontoiur the bone to a smooth and somewhat augmented appearance. While bone grafting is an option, and we are talking about harvesting cranial hone grafts, and its appeal is understandable it is not a great material to use for contouring. Cranial bone grafts are hard pieces of bone, have non-smooth edges, there is no great way to secure them and they will undergo some amount of resorption. (not structurally stable as an onlay graft) Cranial bone grafts are great for large inlay defects but not as a refined forehead contouring material. The far better choice is hydroxyapatite cement (HAC) which works like drywall putty when mixed, can smoothly fill in and augment any bony contour, is structurally stable when hardened (after 10 minutes of application) and the bone will bond to it due to its calcium phosphate mineral composition.

I will always do what the patient wants once when they have been fully informed of their options but in secondary brow bone/forehead contouring HAC is always the better material due to its smooth contouring capabilities.

Dr. Barry Eppley

World-Renowned Plastic Surgeon