A more masculine and prominent brow bones is sought after by some men. Since there are no preformed brow bone implants available, a custom implant made for the brow bones is the only option. The key to designing a brow bone implant is three fold. First, the prominence of the additional brow bone projection needs to be low enough to have the proper effect. Positioning the projection too high creates an unnatural lower forehead appearance. Secondly, the additional projection along the brow ridges afforded by an implant must take into account the supraorbital nerve locations at their exiting foramens along the superior orbital rim. Such relief must be put into the implant design. Lastly the brow bone implant must flow smoothly into the upper forehead so an unnatural brow bone break is not created.
Custom male brow bone implant to increase the projection of the brow prominences particularly out on the lateral brow/upper lateral orbital rim areas.
How much projection the custom brow bone implant should have over the eye is a matter of patient preference
The greater the brow bone projection in the custom brow bone implant the more surface area the footprint of the implant needs to be to blend into the surrounding forehead and not look unnatural.
Custom male brow bone implant to augment a congenitally flat brow bone area.
Custom reconstructive brow bone implant to restore lost brow prominences from prior trauma and reconstruction.
Custom brow bone implant design extends down past the frontonasal junction to build up the flattened frontons/upper nasal region from the prior trauma.
Some men may prefer to augment the entire periorbital region through combined custom brow bone and infraorbital-malar implants
Combined custom brow bone and infraorbital-malar implants may be designed to connect or not connect across the lateral orbital rim.
A very unique form of a custom brow bone implant is the supra lateral brow-orbital implant design. In this case done to complement a prior infraorbital rim implant to achieve a more complete periorbital augmentation effect.
The supra-lateral brow-orbital rim implant is placed through a lower eyelid incision.
In custom brow bone implant designs for men the important footprint question is how far the implant design should go laterally, which is usually down to the frontozygomatic suture line.
How much projection a custom brow bone implant should have and how low on the brow bone it should go are important features in the profile design of the implant.
For the male who either has bulging eyes due to a skeletal deficiency or in the male who is seeking the ‘Hunter Eye’ look, circumferential bne augmentation around the eyes can be done by custom implant designs. This is achieved by combining a custom brow bone implant with custom infraorbital malar implants that have a designed interlocking connection across the lateral orbital rim.
In the circumferential augmentation of the bone around the eyes a key element in the custom brow bone and infraorbital-malar implant design is the connection around the lateral orbital rim. An interlocking design is done over the area of the lower eyelid incision so the connection can be directly seen and secured.
In designing brow bone implants for men who want a much stringer brow bone appearance the implant design on the bone must have an ‘angry’ appearance, just like when one is furrowing their eyebrows.
How much brow bone projection to provide along the supraorbital rim will vary as the brow bones are not a completely straight even horizontal bar of bone across the lower forehead. But at the point of maximal projection most male brow bone implants have projections in the 5mm to 8mm range.
In the Asian female a brow bone implant is designed to augment the flat brow bones and extend up into the forehead in a smooth manner without an obvious transition between the two.
Rather than lowering the eyebrow projection as is done for most males one of the aesthetic goals in female brow bone augmentation is keeping the projection at its existing level…just more of it.
Custom Forehead Implants
Male custom brow bone implant design for flat brow ridges.
Male extended custom brow bone implant design with a higher brow bone break.
Extended lateral orbital rim custom brow bone implant design.
Custom brow bone and infraorbital rim implant designs to create a near circumferential periorbital augmentation effect.
Custom supra brow bone break implant with prior history of Radiesse injections into the lateral brow bone break areas.
Custom lateral brow bone implant designs to join up with previously placed infraorbital rim implants.
Large custom brow bone and jawline implant designs for a strong facial masculinization effect.
Custom brow bone implant design combined with custom nasal, cheek and jawline implant designs for an overall facial masculinizing effect.
Augmentation of the forehead is sought by men that have too much of a retroclined forehead slope and by women who desire a more prominent but rounder and convex forehead shape. (i.e., the forehead is too flat) A custom forehead implant offers the easiest and most reliable method for augmenting this large upper facial area. Most of the time a forehead implant is designed to include the brow bone area to create an overall total forehead effect. When adding horizontal projection to the forehead it is important to factor in the width of the forehead between the anterior temporal lines. In small amounts of horizontal forehead augmentation the implant can remain completely on bone, stopping at the forehead bone to temporalis fascial/muscle transition area. But when the forehead augmentation becomes larger it is important to carry the implant design over the ‘side’ and onto the upper temporal region to avoid creating a forehead bossing/protrusive appearance.
Male custom forehead implant design for correction of a backward sloped forehead.
Male custom forehead implant design to reduce the prominence of the brow bones. (brow bone reduction forehead implant)
Female custom forehead implant design for creating a more vertical fore-head profile and a higher top of the head.
Female custom forehead and midface implants to improve projections of the upper and central face.
Female custom forehead-brow bone implant to provide projection for a flat upper third of the face.
Two different styles of male custom forehead-brow bone implants with different brow bone footprints and shape.
Custom forehead-brow bone implant with a more square forehead shape.
Extended custom forehead-brow bonetemporal implant design for creating a rounded upper facial shape into the anterior sides of the head.
Custom forehead implant design that crosses over the bony temporal lines for increased forehead width and a flatter frontal profile.
Custom male forehead implant design for correction of a narrow fore-head that avoids the more prominent medial brow bone, widens the sides of the forehead and also extends back onto the top of the head for a wid-ening skull effect.
Small custom male forehead implant design to fill in a suprabrow bone depression.
Male custom forehead implant with eagle-shaped brow bone implant de-sign for an upper facial masculinization effect.
Extended custom forehead-brow bone-temporal implant design for a rounder and more projected upper face.
Custom forehead widening implant for a more square male forehead shape with more prominent temporal lines. Adds angularity and width to the narrow forehead.
Custom forehead implant design for the male show wants more prominent brow bones and to correct a sloped forehead above it. The brow bone design incorporates a ‘eagle wing’ shape to the brow ridge area.
Custom forehead implant design for the male who wants a fuller and less sloped forehead above his brow bones and with added forehead width and frontal skull height.
A very unique type of forehead augmentation is the custom supraorbital implant. This is for men who have strong brow bone prominences but do not or can not undergo brow bone reduction surgery. Instead the deep brow bone break or supraorbital region is built up to soften the string brow bone appearance.
Custom supraorbital/brow bone break forehead implant to soften the strong male brow bone appearance.
A custom forehead widening implant style for a female who wants a rounder/fuller forehead that has a more vertical inclination.
One of the key elements in the custom forehead widening implant is that its design must cross over the bony temporal line and extend over the temporal region on top of the deep temporal fascia. A common and often difficult to correct problem is when the temporal part of a forehead implant is placed under the temporal muscle after releasing it as I have seen numerous times from other surgeon’s implant designs and placement techniques. This creates an aesthetically devastating muscular contraction/fullness of the lower temporal region that is very difficult to repair secondarily.
This is a classic male forehead-brow bone implant design to add both a stronger brow bone appearance as well as a straighter and wider forehead shape. The topographic feature of the ‘eagle wing’ design for the brow bones is a key feature of this type of upper facial augmentation in men.
Male custom forehead-brow bone implant design for a stronger brow bone appearance and a broader and less round forehead shape.
Male custom forehead-brow bone implant creating a less retroclined forehead shape. To do so the implant design must go back further on top of the skull to keep a natural transition between the implant and the bone.
When designing a custom forehead implant, whether it is for a male or female, there are numerous design considerations which start with the implant footprint or surface area coverage.
When the custom forehead implant needs to extended beyond the bony temporal lines at the sides of the forehead for anterior temporal widening the footprint of the implant must extend further back on top of the head to create a smooth natural transition into the rest of the head shape.
For the male with a rounder and softer forehead shape that lacks much visible brow bone prominences the combined forehead-brow bone implant provides increased brow bone definition as well as improves the width of the forehead.
Custom forehead implant design (minus the brow bones) to correct a backward sloped and narrow forehead in a male.
Male custom forehead implant design for correcting a backward sloped and narrow forehead. The key in the design is how wide should the implant go to or beyond the bony temporal line.
New three-piece fronto-temporal head widening implants with a forehead overlay piece to replace previous fronto-temporal implants. The objective of the new implant designs was to make the forehead a little less square with some increased forehead augmentation and increased augmentation at the posterior temporo-parietal area on the back of the skull.
An extended custom forehead implant can be extended back onto the skull to merge with a back of the head augmentation for a total top of the head augmentation effect. It is designed in two pieces so it can be placed through a single small scalp incision on top of the head.
Forehead augmentations in men do not always have to include the brow bones. They often want to improve a backward slope to their forehead as well as increase its width with more evident bony temporal lines.
For the male who has concerns about a narrow forehead and desires greater width and convexity a one piece custom forehead-temporal implant design can create a smooth and homogenous upper facial third reshaping effect.
Male custom forehead-temporal one piece implant design.
Augmenting the narrow and backward sloped forehead in a male with typical flat brow bones requires a forehead implant with a large surface area that blends into the temporal region across the bony temporal lines.
When the forehead and brow bones are augmented it becomes important that the implant design extend far enough over onto the top of the head as well as onto the sides (temporal region) to have an effect that looks natural. (blends into the rest of the head shape)
In the narrow forehead separate custom forehead implants can be designed just for the sides of the forehead provided that the central forehead projection is adequate. Such widening forehead implant designs must cross over the bony temporal line at the side of the forehead and extended onto the deep temporal fascia. (not underneath it)
In widening the narrow forehead, where it is two separate pieces as in this patient’s design or whether it is an implant that covers the entire forehead , the implant design must extend further back onto the top of the skull. A narrow forehead does not exist in isolation. Most commonly it is part of an overall narrow head shape.
In plagiocephaly, while the flat side of the back of the head is usually the patient’s biggest concern , there may also be a contralateral frontal component as well. This can be treated by unilateral custom forehead implant to improve the symmetry of the forehead and brow bones.
As part of an overall facial reshaping approach the narrow forehead can be widened (leaving out the brow bones) and extended into the temporal region. When widening a forehead it is always necessary to extend onto the temporal muscle area beyond the bony temporal line at the side of the forehead. This is done on top of the deeper temporal fascia NOT done onto the temporal fossa bone.
Custom forehead implants can be combined with other skull implants provided the scalp has the ability to stretch enough to accommodate the implant volumes. In this case a new custom forehead-brow bone implant was placed on top of an existing PEEK forehead brow bone implant. In addition a new custom back of the head skull implant was placed to improve its flat shape. Both were done during the same surgery.
A new custom forehead-brow bone implant can be placed on top of an existing one for additional augmentation/definition.
A custom forehead implant, which is one type of a custom skull implant, can be combined with other skull implants at the same time IF the volume of the combined implant does not exceed the scalp’s ability to stretch to accommodate them.
In reshaping of the brachycephalic short skull the combination of custom forehead and back of the head skull implants can increase the front to back skull length as well as give a more rounded shape to the head.
Changing the vertical angulation of the forehead typically does not involve the brow bones and may not need to cross the bony temporal lines to do so…provided the amount of angulation change is not significant.
When a significant backward slope to the forehead exists in a male it may appear that the brow bones are too prominent, but computer imaging will show that it is the forehead that is at fault. A custom forehead implant wil correct the slope of the forehead and make the brow bones look less prominent.
In a backward slope to the forehead the ‘imprint’ of the missing bone can be seen above the brow bones and between the bony temporal lines. A custom forehead implant wil make up for the lost forehead bone and male the overall upper third of the face look more proportionate.
Male forehead reshaping with a combined procedure of a custom forehead implant for severe backward slope to the forehead and brow bone reduction by burring. (minor reduction) While his brow bones looked like they protruded too much the primary cause was the near 45 degree backward angle of the forehead. (men are generally closer to an 80 degree forehead slope)
In the female to male transgender patient masculinizing the upper third of the face requires a custom forehead-brow bone implant. This achieves a more prominent brow bone and forehead width appearance.
A male custom forehead-brow bone implant adds forehead width along the bony temporal lines as well as making the brow bones more visually evident.
A custom forehead implant in a female is often used to increase the verticality of the forehead in profile. (decrease the backward forehead slope) In this vase it took 9mms of added upper forehead projection to do so. This also requires that the extent of the implant on top of the head must go fairly far back to have a natural transition onto the top of the skull.
When increasing the vertlcal inclination of the forehead it is important to have a shape that is consistent with the patient’s gender. For a female a rounder or more convex shape is usually desired.
Male who desired a larger and wider custom forehead brow bone implant to improve upon his initial good result. To make the temples wider it becomes necessary to extend the footprint of the implant to blend better onto the top and sides of the head. As the implant gets larger it also becomes necessary to make it a two-piece implant so that the scalp incision can remain the same length.
Improving on a 1st custom forehead brow bone implant result with added brow bone projection and increased temporal width.
When the backward slope of the forehead is more significant the forehead augmentation may need to extend all the way back to the vertex of the skull. In this case the patient also want to build up the back of the head so the implant design became a larger two piece implant approach.
The trickiest part of any forehead implant design is whether it needs to cross over the bony temporal line to add forehead width. And if so how far should it cross over. (partial or complete temporal coverage)
In the forehead that is narrow and lacks projection a small standard forehead implant provides little benefit as the problem is not just limited to between the bony temporal lines. (the forehead itself) Rather it is a forehead shape issue that requires augmentation further back onto the top of the head as well as along the sides.
A custom forehead-brow bone-temporal implant implant is a custom implant design that changes the entire shape of the front half of the skull.
Isolated brow bone augmentation can be done with a custom brow bone implant placed using an endoscopic technique through a small scalp incision.
For the male that lacks adequate brow bone projection a custom brow bone implant can be placed through a small scalp incision. The lack of any visible medial brow bone mounds indicates the lack of brow bone projection due to small frontal sinus development.
To complete a front to back skull elongation reshaping which was started years ago with an initial custom back of the head skull implant the forehead was addressed secondarily with a custom forehead implant. This is a not atypical skull reshaping approach in the Asian patient who more commonly has decreased anteroposterior skull length.
Custom Temporal Implants
The temporal area is a unique facial implant site for augmentation because it is not a skeletally based site. It is really augmentation of the temporal muscle, whether it is the non-hair bearing traditional temporal hollows (anterior temporal zone) or the hair-covered posterior temporal zone above and around the ears. While there is currently a standard temporal implant style and sizes, it provides augmentation for the temporal hollow region just above the zygomatic arch and to the side of the eye. More extended anterior temporal augmentation that extends up to the forehead (temporal line) or augmentation of the side of the head (head widening) requires custom implant designs. These custom temporal implants are placed in the subfascial location on top of the temporalis muscle where they create the appearance of greater muscle mass and an increased fullness.
Custom high anterior temporal implant design for augmentation of up-per temporal hollowing by the side of the forehead
Custom lateral forehead-temporal implant design to widen the side of the forehead over the bony temporal lines.
Custom temporal implant design for correction of the entire anterior temporal hollowing area.
Custom temporal implant design to go along with a jawline implant to match its masculinization effect by creating a forehead widening effect.
Custom temporal implant design for replacement of prior PMMA bone cement augmentation placed down at the bony temporal fossa.
Custom temporal implant design for augmentation of the posterior tem-poral and anterior parietal skull areas.
Custom posterior temporal implant design for a head widening effect.
Custom anterior temporal implant design for a head widening effect.
Widening the head through a combined anterior and posterior custom temporal implant.
Custom forehead-temporal widening implants for the narrow head shape.
Custom forehead-temporal (head widening) implants must cross over the bony temporal lines to create a confluent head widening effect that flows naturally onto the top of the skull.
A head widening implant must wrap around the side of the head, crossing both anterior and posterior temporal lines, for a smooth and continuous look. They are placed through a post auricular incision (behind the ear) supplemented with two very small positioning/fixation incisions in the scalp.
Patients often learn what their ideal aesthetic needs are by having an initial custom implant design placed. In this case of a custom forehead-temporal implant the patient decided that some dimensional changes of the implants would look even better better. Thus a new custom forehead-temporal implant was designed with less temporal line prominence at the sides of the forehead and a new thin forehead piece which connected the two larger side pieces for a better forehead shape result.
The new custom forehead-temporal implant replacements provided a different type of forehead shape with more fullness along the posterior temporal regions at the back of the head. Only by having the first custom forehead-temporal implant in place would one ever know how to make these type of aesthetic implant design changes.
Significant temporal hollowing is often a part of an overall natural thinner face which can become quite pronounced in lean athletic patients. In treating the temporal hollowing of a naturally thinner face the forehead is usually narrow as well. Thus in custom temporal implant designs it may be necessary to include a lateral part of the forehead as well. These extended temporal-forehead implants can be placed through an incision in the crease of the back of the ear and must be placed on top of the deep temporal fascia to be able to cross over the bony temporal line onto the forehead.
For the narrow head from the forehead to the back of the head a custom extended temporal-forehead implant is needed to create a complete head widening effect. It must be placed on top of the deep temporal fascia to be able to cross over onto the subperiosteal plane of the forehead and the parietal bone on the back of the head.
In the extended temporal-forehead implant it wraps around the sides of the head creating a complete head widening effect. It is placed through an incision behind the ears in the postauricular crease.
For females with significant temporal following, particularly when it is asymmetric, a custom temporal implant design is he optimal method for improvement. As it provides complete augmentation between the superior temporal line of the forehead, anterior lateral orbital rim, inferior bony zygomatic arch and the variable posterior temporal hairline areas.
Widening a narrow forehead often requires an extension onto the temporal areas as well as the forehead and temples are part of an overall skull shape. Beyond the frontotemporal hairline lies the exposed forehead and temporal skin which is an aesthetic unit. Such large surface area skull implants often require a split design to fit through smaller incisions.
How far back along the temporal region a custom widening forehead implant must go depends on how much side of the head widening a patient wants….if any.
In forehead asymmetry a unilateral or one-sided custom implant design is the ideal method of correction. Using a mirroring design technique the normal side of the forehead is ‘mirrored’ over to the less projected asymmetric side to determine the exact implant dimensions needed.
The forehead being one of the five surfaces of the skull means that in correction of asymmetries the surface area of involvement is much bigger than is often appreciated. Thus a forehead deficiency correction is not just isolated to the forehead but must extend further onto the top of the skull for proper contour improvement.
Widening the narrow side of the head requires an implant design that covers the entire temporal region from the side of the forehead all the way to the back of the head. Such an extended temporal implant needs to be placed on top of the deep temporal fascia.
The impact of the extended temporal or the head widening implant can be best be appreciated in the submental view where even 7mms of maximum implant width on each side makes a major head shape difference.
