Where Are The Incisions for Forehead Horn Reduction In A Bald Male?

Q: Dr. Eppley, I think I have what is referred to as frontal bossing and/or frontal horns. My forehead also appears asymmetrical.I’ve just always known that I had an unusually large forehead, which has been a source of insecurity throughout my life.  I am contacting your office to see if anything can be done to address the aforementioned issues, with minimal risk and without significant scarring. justtso you know I am 45 years old. As you will see from the pics, I am also bald, which raises an issue as to whether any needed incision(s) could be readily hidden. 

A:In forehead reshaping surgery in a bald patient there is no good place to put an incision. For the very highly motivated patient (one who is willing to accept some visible scarring) I would use two small mid-forehead incisions placed in the existing horizontal wrinkle lines  and would  not even connect them across the middle. (see attached picture) This gives the incisions the best chance to heal in a location which already has a natural wrinkle and is parallel to the RSTL (relaxed skin tension lines) of the forehead.

That being said, in the end it comes down to the choice between which aesthetic problem does the patient prefer…the present forehead shape with no scar or a reduced forehead with some slight scarring. Every patient will view that choice differently.

Dr. Barry Eppley

World-Renowned Plastic Surgeon