What is forehead contouring?
Forehead contouring is a cosmetic surgery involving a patient’s forehead area from the upper eyebrow to the scalp line and from one side to the other of the head. When a patient is undergoing a forehead contouring surgery, the earlier mentioned facial area is made slightly smoother and less protrusive.
What influence does the forehead have on one’s appearance?
The forehead is a very prominent and visible facial area. While it is not the most
dominant facial feature, it does have an influence on one’s appearance in numerous
The forehead does have an influence on gender appearance. In men, the brow ridge
(bossing or prominence above the eyes) is stronger and the forehead angles more
steeply away from the eyes. In women, the forehead does not have a prominent brow
ridge, tends to be more round, and angles more vertical above the brow rather than
more backward sloping as in men.
A forehead can often be seen as too ‘big’ because of the distance between the
eyebrows and the frontal hairline. When more than 6.5 cms exists between the two,
the forehead will look elongated or large. This may be the result of frontal hairline
recession in men or the natural position of the hairline in women.
How is forehead reshaping done?
Changing the shape of the forehead can be done in three ways. Brow ridge (bossing)
reduction, brow ridge augmentation, or altering the slope or shape of the forehead
between the brow bone and the top of the skull under the hairline are the common
They all share one common theme, the need to use a coronal or scalp incision for
access to do the procedure. This is a more significant aesthetic consideration in men.
Surgically changing the brow bone uses different techniques depending upon whether
one is reducing or building it up. While some minor bone alterations may be able to
be done endoscopically (from above) or through the upper eyelids (from below),
major changes require the liberty of unfettered access by the turn down of a scalp flap.
How is brow bone augmentation done?
Building up a deficient or over-reduced brow ridge requires the use of synthetic
materials which are added on top of the bone. The two most commonly used
cranioplasty materials are acrylic (PMMA) and hydroxyapatite. (HA) Each material
has its own advantages and disadvantages and either one can work in experienced
PMMA incurs less cost to use and has a very high impact resistance. HA is more
expensive with a lower impact resistance to trauma. Both can be impregnated with
antibiotics and shaped during the procedure. How much material to add and where to
place it is very much like sculpting and requires a thorough discussion before surgery
with the patient.
Solid implants composed of silastic, Gore-tex, or Medpor, can also be used. They
require more effort at shaping and must be held in place with tiny titanium screws.
Their cost is intermediate between PMMA and HA.
Can other areas of the forehead be reshaped besides the brow bone?
The forehead (frontal bone) between the brow ridge and the front of the hairline can
also be reshaped. It can be made flatter, more round, narrower, or wider. Changes can
be done in either profile, width, or both. This is done through either burring of the
prominent areas, adding material on deficient areas, or a combination of both.
What is the recovery after forehead reshaping ? What complications can occur?
Aesthetic forehead surgery is usually done as an outpatient procedure. Depending
upon what other procedures may be done with it, it may require an overnight stay in
the surgical facility. A wrap-around forehead dressing is put on at the end of surgery
and is removed the next day. In some cases, a drain may be removed (not commonly)
and it is removed the next day also. Ther6e is some mild pain afterward but much of
the forehead skin will be numb for awhile. Pain is easily controlled by pills. There
will be some swelling afterwards which is driven downward by the dressing and
gravity which affects the eyes and upper cheeks. It is most evident by two days after
surgery and is largely gone within seven to ten days after surgery. Most patients
return to work in two to three weeks. absorbable sutures are used in the scalp so there
is no need for suture removal. One can return to working out in two weeks after
Complications of significance are very rare with forehead surgery. The forehead skin
will be numb but normal feeling will return in most patients within six to eighty
weeks after surgery. It is possible to not get back all of your feeling. The biggest
concern is aesthetic…did we achieve what our goal was? Is the forehead contour
smooth and even? Is it too much or too little?
What can I do if my forehead is too long?
Usually a long forehead is a female concern. It is evident when the distance between
the eyebrows and the frontal hairline is aesthetically too long, usually greater than 6.5
or 7cms in length.
The length or size of the forehead skin can be reduced by scalp advancement (hairline
lowering. This is conceptually a ‘reverse brow lift’. An incision is made at the frontal
hairline and the scalp behind it is loosened and brought forward over the fixed
forehead skin. The underlying forehead skin is then removed and the hairline closed
in its new lower position. A frontal hairline can be advanced between 1 and 2.5 cms,
which often makes for a significant difference.
How is forehead contouring performed?
Similar to a brow lift surgery, the forehead augmentation procedure involves the
exposure of the entire relevant surgical area. Then the bone is identified and the
specific area that is indented is located and noted. Following these steps, the surgery
involves the insertion of a material which will contribute to giving a nice and smooth
looking forehead. Also referred to as a “bony augmentation,” this procedure involves
the use of a substance known as polymethylmetacrylate which is bone cement.
When bone cement is placed inside a patient’s forehead, it provides a permanent
result. At no point in time do patients have to remove or amend the substance.
However, if a patient makes the decision to have the bone cement removed from his
or her forehead, this can be done, as well.
When bone cement is used on a patient, it will stick right on the bone and feel exactly
like the bone. Consequently, patients will enjoy a smoother forehead and a more
augmented look. For most patients, this is more desirable compared to a forehead
that’s pushed in.