Frontal Bossing and Forehead Aesthetic
The area between the eyebrows, also called the glabella, is prominent in men due to the oversize frontal sinuses. There are different degrees of prominence from type I to type III as described by Dr Douglas Ousterhout. The surgical option varies from a simple burring of the bone to a more complex frontal sinus outer table repositioning and reconstruction.
Usually a bicoronal incision (from one ear to another) is needed to gain access to the area. The scar is planned in the hair bearing area or just in front if your hair line is already high. The scar heals usually very well. An eyebrow lift as well as a scalp lowering can be done at the same time.
Bicoronal Incision
If the bossing is slight a simple burring of the excess will be sufficient. In case of marked bossing, we will need to saw the bone and set it back. If needed some very small titanium screws and plates may be used to hold the bone pieces together. They are usually not palpable or visible.
In the vast majority of cases a combination of burring and cranioplasty is done. The cranioplasty consist of filling the part above the frontal sinus to give a convex shape to the forehead. Bone substitute or acrylic can be used.
X rays are sometime necessary to asses the frontal sinus and personalize the surgery.
This procedure is often done with a brow lift and scalp advancement. An orbital rim recontouring can also be done at the same time if necessary.
Rim Recontouring
You should expect partial numbness of the scalp behind the scar, swelling and bruises for a few weeks.
The complications are very rare and the risk is less than 1%. It includes: infection, bleeding and nerve injury.