The forehead makes up about a third of the surface area of the face. Although most people are unconcerned about the shape of their forehead, its overall size and shape can have an affect on facial appearance. Male and female foreheads are very different shapes and forehead form affects the masculinity and femininity of the face.
The top of the forehead is marked by the hairline, which has a very different contour and position in men and women.
The lower part of the forehead is outlined by the eyebrows and supra-orbital ridges, (the ridge of bone just above the eyes and nasal bridge).
At the sides of the forehead are the bony temporal ridges to which the powerful temporal muscles attach.
The forehead in males tends to be more convex and backward sloping than in females. The hairline is generally higher particularly at the sides than in females.
It is common to have a fairly pronounced supra-orbital ridge, which gives a masculine appearance. An over-pronounced supraorbital ridge can produce an unfriendly or aggressive appearance.
Female foreheads tend to be rounded with a flat central portion. There is almost no frontal bossing. In profile, female foreheads are more vertical instead of backward sloping. At the side of the forehead, the brow ridges taper smoothly towards the temples, unlike in males, where the sides are more boxy or square.
Procedures To Correct Forehead Shape
Forehead Augmentation and Contouring
Small irregularities in the forehead can often be treated using bone cements PMMA (acrylic) and HA (hydroxyapatite cement) are most commonly used for this purpose.
For larger augmentations, implants are used. These can either be standard implants or custom made patient specific implants. Custom made implants are made using CT scan data from the patient and are designed to fit perfectly and produce accurate carefully planned augmentation. Custom made implants can often be placed through smaller incisions than standard pre-formed implants.
Forehead and Brow Reduction
Reduction of forehead convexity (bossing) can be achieved by burring (shaving), the forehead bone but the amount is limited by the thickness of the skull bone
An overly prominent brow ridge is often due to an increase in thickness of the bone in this area combined with an enlargement of the frontal sinuses. Brow reduction can be achieved by burring alone, or burring combined with infracture of the wall of the frontal sinus.
Most forehead and brow procedures require a scalp incision for best results. Occasionally endoscopic approaches or upper eyelid incisions can be used.
Temporal concavity or hollowing is usually due to underdevelopment of the temporalis muscle. In can occur naturally, but is also seen after weight loss, some autoimmune diseases and after neurosurgical operations. Temporal implants, fat injections and artificial fillers are all used to treat this problem.
Temporal bulges at the side of the head can be a more difficult problem to treat. The skull bone in this area is very thin and so cannot be reduced by burring.
Many temporal bulges are due to overgrowth of the temporalis muscle. Temporalis muscle reduction can be achieved by Botox injections or surgical reduction
Frequently Asked Questions
During your consultation, your goals for the surgery will be discussed. Physical examination and photographic analysis are all that is needed for simple problems. Often a CT scan is needed to analyse the shape of the bone and determine the position and size of the frontal sinuses. Custom made implants are designed from this CT scan. A second consultation may be needed to discuss the surgical plan.
You will be asked about certain medical conditions that could cause problems during or after the procedure, such as uncontrolled high blood pressure, blood-clotting problems, or the tendency to develop large scars.
You should not take aspirin or non-steroidal anti-inflammatory drugs such as Nurofen for two weeks before your surgery. These drugs increase the risk of post-operative bleeding and have an adverse effect on bruising. If you smoke, you will need to stop smoking for two weeks before surgery and a week afterwards. Smoking reduces the blood flow to the skin and can prevent healing. You will need someone to drive you home after your surgery and to help you out for a few days at home.
Complications are rare and usually minor, however the possibility of complications must be considered. Formation of a broad scar is a rare complication. This may be treated surgically by removing the wide scar tissue so a new, thinner scar may result. Also, in some patients, hair loss may occur along the scar edges. A small amount of hair loss in the region of the incisions is very occasionally seen although this will recover over a period of time. Loss of sensation may occur on the scalp or forehead. It is usually temporary, but may be permanent in some patients. Infection and bleeding are rare, but are still possibilities.
No preoperative markings are needed. Before performing the surgery, the hair is parted along the incision lines and held in place with hair gel.
Forehead reshaping procedures are usually done under general anaesthesia as day case procedures. They maybe undertaken through a scalp (coronal) incision resulting in a scalp scar across the top of the head that ends above the ears. Endoscopic and limited access incisions are suitable for some patients.
A postoperative head bandage helps to reduce swelling and a drain may be placed until you leave hospital.
Mild swelling and bruising is common following forehead surgery. In order to reduce this, you will be nursed sitting up after the surgery and also asked to sleep with 2 or 3 pillows for the first few days. During the first week you should avoid straining and bending down, as this tends to increase the swelling. The stitches or staples used to close the incisions are removed after one week.