Brow Bone Reduction

All primates have a bony ridge or prominence above their eye sockets known as the brow ridge. It is medically known as the supraorbital ridge or supraciliary arch. Human eyebrows are located on the lower margin of the supraorbital ridge.

The brow bone and eyebrow play an important role in facial aesthetics and can greatly affect one's overall appearance. The shape and position of the brow bone can greatly influence the look of the forehead. A well-defined brow bone can provide a more youthful and attractive appearance. It also greatly influences the overall facial expression and can create a more open and awake look. 

A protruding brow bone, which is sometimes called the Neanderthal forehead or frontal bossing, makes the face look more aggressive and masculine. This is an undesirable physical characteristic, especially in women. Fortunately, aesthetic surgeons can correct the forehead prominence through a procedure called brow bone reduction.

Browbone reduction, also known as forehead contouring, is a surgical procedure that involves reshaping the bones of the forehead to create a more aesthetically pleasing appearance. This can include reducing the prominence of the browbone, creating a more defined brow ridge, or smoothing out any unevenness in the forehead. The procedure can be performed using a variety of techniques, including burring, osteotomy, or the use of implants. The goal is to create a smoother forehead contour.

Good candidates for brow bone reduction surgery are typically individuals with a prominent brow bone or brow ridge that they would like to smooth out for aesthetic reasons. This can include people with a high or protruding or uneven brow ridge that gives the person a masculine and frowning look. People with congenital conditions such as a thick or heavy brow bone or a high forehead can also be good candidates for surgery.

The candidate should be in sound physical and mental health and have realistic expectations about the outcome of surgery. A qualified plastic surgeon can determine if you are a suitable candidate for surgery and the most appropriate options.

Depending on the individual's needs and desired outcome, several types of brow bone reduction procedures can be performed. These include:

Shaving/burring

For some patients with a very small sinus and thick frontal wall, burring away the excess amount of bone can be done as part of a brow bone reduction procedure. This technique is typically referred to as "feminization of the forehead," but it may not be suitable for everyone. 

Bone flap technique

the brow bone reduction technique needed for most men is the well-known bone flap technique. This is the technique in which the outer table of the frontal sinuses (brow bone protrusion) is removed, reshaped, and then re-implanted. 

Endoscopic brow bone reduction

This procedure is like a traditional brow bone reduction but is performed using an endoscope, allowing for smaller incisions and faster recovery.

Osteotomy

This procedure is for patients who are not satisfied with their previous results. It is possible to achieve maximal or extreme brow bone reduction by removing the sinus and packing it with HA cement, then burring all surrounding bone.

Browbone reduction is an invasive procedure and requires a skilled surgeon. It is best to discuss with a well-trained plastic surgeon for a personalized treatment plan that's suitable for you.

Preparing for a brow bone reduction surgery typically involves several steps, including:

1. Consultation: Before the surgery, you will have a consultation with a plastic surgeon to talk about your goals, medical history, and any medications you are currently taking. The surgeon will also examine your face to decide if you are a good candidate for the surgery and to plan the best surgical approach.
2. Medical evaluation: You may need a preoperative medical evaluation, including blood tests, to ensure that you are healthy enough for the surgery.
3. Quit smoking: you will be asked to quit smoking at least two to four weeks before and after the surgery to avoid complications during the healing process.
4. Medication: Inform your surgeon of any medications you are currently taking, including over-the-counter drugs, supplements, and herbs, as you may be advised to stop taking them before the surgery.
5. Arrange for help: Make sure someone drives you home after surgery and stays with you for 24 to 48 hours.
6. Follow the surgeon's instructions: Your surgeon will give you specific instructions on preparing for the surgery, such as what to eat or drink before and when to stop eating and drinking.
7. Discuss your expectations: It's important to discuss your expectations with your surgeon and to have realistic expectations about the outcome of the surgery.

It is important to follow these steps so your surgery goes smoothly and your recovery is safe and successful.

Browbone reduction can take several hours to complete, depending on the extent of the surgery. It is typically done under general anesthesia. Depending on the extent of the surgery, an endoscope may be used to reduce the size of the incisions and minimize scarring.

During the procedure, the surgeon removes a bone strip from the forehead. This strip is usually around 5cm long and 3cm wide. It's taken from the middle of the forehead. This will cause a reduction in the height of the forehead. The skin is then pulled down to cover the area where the bone was removed, and sutures are used to hold it in place. A typical browbone reduction can be as follows:

• The surgeon will make an incision along the hairline to reveal the forehead bone.
• The skin is pulled forward on the forehead.
• The solid orbital rims are shaved.
• Then a portion of the brow bone is carefully removed using specialized tools. 
• The remaining bone is then reshaped to create a more desirable contour.
• A titanium micro screw is used to secure the finely refined bone plate.
• The skin is then repositioned and secured with sutures or staples. 

It depends on the individual health, the extent of surgery, and how quickly patients recover. However, it is generally a multi-week process that requires significant downtime.

• Downtime: After the surgery, the patient might need to take several weeks off from work and other daily routine chores to allow the body to heal properly. The patient should expect to experience swelling, bruising, and discomfort around the incision site. Following the surgeon's instructions for post-operative care is important to minimize these symptoms and promote healing.
• Pain management: The patient may experience some pain or discomfort during the recovery period. It's important to take the medication as the surgeon directs to minimize discomfort.
• Post-operative care: A bandage will be applied to the incision site, and the patient must keep the area clean and dry. The patient should avoid strenuous activity and sleep with his head elevated to reduce swelling. After surgery, the patient may wear a compression bandage for several weeks. Patients will be scheduled for follow-up appointments to monitor healing and remove sutures. Bending, heavy lifting, and direct sunlight exposures are usually not recommended.

Always follow your surgeon's instructions for post-operative care to minimize complications and promote healing. The patient should contact the surgeon if they experience unusual symptoms or complications.

Like any surgical procedure, brow bone reduction carries risks and potential side effects. Discussing these risks with a qualified plastic surgeon before deciding to undergo the procedure is important.

Some of the potential side effects and risks of brow bone reduction include:

• Bruising and swelling: These are common side effects of the surgery and can take several weeks to subside.
• Scarring: A scar may be left on the incisional site, which may be noticeable or hidden depending on the location of the incision.
• Numbness or tingling: Some patients may experience numbness or tingling in the area around the incision site. This is usually temporary but may be permanent in rare cases.
• Infection: Any surgical procedure has the risk of infection, which can be minimized through proper care and wound management.
• Hematoma: A collection of blood outside blood vessels is called a hematoma. It can cause pain and swelling.
• Injury to nerves or blood vessels: The surgery may cause injury to nerves or blood vessels, resulting in temporary or permanent loss of sensation or function.
• Asymmetry: The bone may be asymmetric after the surgery, which may require revision surgery.
• Unsatisfactory outcome: The patient may be unhappy with the results of the surgery, which may require revision surgery.
• A small dent/hole may become visible after the bone-shaving procedure if the frontal bone becomes too thin.
• A heavy dolphin-like forehead can be produced by excessive frontal sinus filling and shaving techniques.

Remember that these risks and side effects are rare but should be discussed with the surgeon before the surgery. 

Depending on several factors, such as the location of the surgery, the surgeon's experience, and the complexity of the procedure, the cost of a brow bone reduction procedure can vary. In the United States, brow bone reductions can cost anywhere from $4,000 to $15,000.

The procedure cost includes additional expenses such as anesthesia fees, operating room fees, and post-operative care. If the procedure is considered medically necessary, verify with your insurance provider to confirm what is covered. When it comes to plastic surgery, the lowest price does not guarantee successful results. Quality of care, qualifications, experience, and safety record, play a big role in choosing the right surgeon and your choice of surgeon should not be based solely on cost. 

Several alternative options for reducing the appearance of a prominent brow bone or forehead do not involve surgery. These include:

• Injectable fillers: Injectable fillers can add volume to some parts of the forehead and reduce the appearance of a prominent brow bone. This non-surgical option can be done in the office and has minimal downtime.
• Botox: Botox can temporarily relax the muscles with which you give a frown expression, which emphasizes the appearance of a prominent brow bone. 
• Makeup: Makeup can contour the forehead and create the illusion of a smaller brow bone.
• Hair styling: Hairstyles that cover the forehead can also reduce the appearance of a prominent brow bone.

These alternative options are not permanent and produce temporary results. Additionally, these options may not be suitable for all patients and may not provide the same results as a surgical procedure. 

Can I combine brow bone reduction with other facial procedures? 

Yes, this procedure can be combined with other facial procedures such as forehead reduction (hairline lowering), facelift, or brow lift.

How long will the results last?

The procedure results are permanent, but the patient may experience some changes in the contour of the face as they age.

Can I reduce my brow bone naturally without surgery?

Many people have an inherited brow bone prominence or "bossing" and it cannot be changed by any means other than surgery. However, you may be able to reduce the appearance of the browbone prominence with nonsurgical options such as fillers or fat injections or camouflage it with makeup or certain hairstyles.