Brow Reduction

The browbone is created by the anterior wall of the frontal sinus. Some patients have a very aerated frontal sinus and a thin anterior wall, while others may have a thick wall with a small sinus cavity. It is impossible to tell how thick the sinus wall is just by looking at the outside. A CT is needed for presurgical planning. Doctor spends time reviewing every detail of the CT scan before surgery; planning where she will make the cuts in the bone. This planning, done before your surgery, saves you time in the operating room. Detailed planning leads to less OR time, less anesthesia, and better results.

TYPE 1 Brow  Reduction

Type 1 Brow Bone Reduction

The first type of reduction is commonly referred to as a “Type 1 Browbone reduction, or browbone shave” In this procedure, the bone is burred down. This procedure is for patients who have a very thick frontal sinus plate and can have at least 5mm of bone removed by burring. This is not common, because 90-95% of patients have only a very thin anterior wall. Still, it may be an option for the 5% of patients who do not have a developed frontal sinus. In this case, there is no “cave,” the shape is more like a big rock. In this case the bone can be burred a significant amount. A type 1 brow bossing reduction may also be an option for patients who do not have much bossing to begin, and desire only a small improvement.

TYPE 3 Brow Bossing Reduction

Type 3 Brow Bone Reduction

In this procedure, the anterior wall of the sinus is removed and then reset in a more posterior position. This is also called a frontal setback. Imagine that the front door to the cave is being moved further back into the cave. The newly positioned bone is held into place with a tiny plate and screws. These can be titanium or plates that absorb over time. This plates are less than 1 mm thick (0.3mm) and cannot be felt through the skin. They are made from titanium and are completely inert. They are safe for MRI, Xray, or any scan the patient may need in the future. They are too small to set off a metal detector and cause no issue with scanners at airports, etc.

Lateral Orbital Rim Reduction

Whether the patient has a Type 1 or a Type 3 brow bone reduction, the lateral orbital rims usually need to be reduced as well. These bones are very thick and can generally be reduced significantly with a burr. Reducing the orbital rims helps open up the eyes. It allows light from above to illuminate and brighten the eyes.

Doctor uses a special technique where she burrs down the lateral portion of the orbital rim, but also burrs a small amount vertically (upward) to open the eye. It has been shown in studies that although men have a more prominent orbital rim, women have larger orbits. Doctor works in all directions to reduce the rim, but also to enlarge the orbit (eye socket) to make the eyes look bigger and brighter. The eyes then appear brighter, softer, younger and more feminine.

Which procedure each patient needs is determined by a CT scan. The majority of patients need to have the bone reset (Type 3) in order to achieve a dramatic difference in the contour of the forehead. In the consultation with Doctor he will review your CT scan, your desired goals, and determine if the procedure meets your needs.

Where is the incision?

Incision point: Doctor can do a trichophytic along the hairline if you are also seeking a hairline advancement or she can do a coronal incision where the incision is placed within the scalp.

With a pre tricheal incision, the scar hides in the hairline, between the hair and the forehead. A trichophytic incision means that the incision is made with a slant, so that hairs can eventually grow through the scar. The advantage to this technique is the hairline can be advanced forward at the same time. The disadvantage is that there is a visible scar, and this should not be used in patients who have a history of keloid or hyperpigmented scars.

A coronal incision is one where the scar is placed in the hair. The advantage is this usually heals so the scar is invisible. The disadvantage is that the hairline cannot be advanced and may be raised a small amount with the coronal incision.

For more information, see our page on hairline advancement.

Can I do hair grafts with this procedure?

Hair grafts can be done with a brow bossing reduction, but the timing depends on the type of incision. If patients opt for a coronal incision, the grafts may be done within a few days. Doctor office does offer follicular unit extraction transplants (FUE/FUT), hair grafts that are harvested and implanted one by one. This is done awake in the office so patients do not need to spend money on extra OR and anesthesia time. Patients who opt for coronal incision and grafts can do both in the same week, so there is only one recovery and one downtime.

Hair grafts can also be done on patients who opt for a pre tricheal incision. In this case we recommend that patients wait 4-6 months for the scar to be healed and the area to be re vascularized for optimal graft uptake.

Am I a good candidate?

Any, male or female seeking to reduce a prominent brow bone can be a good candidate. Patients should be in good health, non smoker, with no history of poor wound healing.

What to expect on procedure day?

Expect an early arrival to the surgery center. This is so the surgery center staff can fully prep you before your surgery & that the procedure can get started by 7 am. You will get to meet with Dr Rodman before your surgery.

After the procedure is over, the medical staff will wake you up to prepare for your aftercare. If a patient only has forehead procedures performed, they usually do not have to stay the night at the hospital. The patient may leave the hospital same day, but it is mandatory that a responsible adult sign you into their care for 24 hours. This person may be a family member, friend, or hired an medical professional. This is the law in Texas and is created for patient safety. An Uber or Lyft type ride service will not suffice, an adult must sign a paper assuming care for you in order to be discharged.

We understand that not everyone has friends/family in the area that are able to take off work. We also have the option of hiring a nurse/caregiver for aftercare. Our patient care coordinator can help arrange any aftercare needs. Our aftercare team has been vetted by Dr Rodman and the Face Forward staff, and we trust them to take excellent care of patients.

What should I expect after surgery?

Surprisingly, patients do not have much pain after this procedure. We do give pain medication to be taken as needed, but most patients can switch to plain tylenol within a day or two. Patients generally complain of headache and tight feeling, especially those who have had a hairline advancement at the same time.

Some patients will have swelling, primarily around the eyes. A majority of this swelling typically subsides within 2 – 4 days. Some patients may also have bruising, again around the eyes. This takes about one week to resolve.

The first night patients will be sent home with a large dressing on the head. This is to protect the incisions and apply a small amount of pressure to prevent bleeding. A drain may be used to absorb any extra fluid that accumulates under the scalp the first night. This bulky dressing is for the first night only, and is removed the next day.

Recovery time needed?

A week off from work is recommended. A reduced work schedule or additional week off may be needed for the second week for patients who have high physical demands at their job. Each patient’s circumstances such as health history, other procedures performed, type of work, among many things may extend this window to 4 weeks. Doctor can discuss specifics that fit your surgical plan and the demands of career.

During this recovery period, Doctor will see you several times. The first visit will be the day after your procedure. Your dressing will be removed and your incisions checked. If a drain was placed it will usually come out at this time. The second visit will be at approximately day 9 – 11 to remove the remaining sutures. Patients who opt for other procedures at the same time may be seen for additional visit at day 6.

What do I need to do for aftercare?

An integral part of aftercare is keeping the incision clean while treating it a minimum of 3 times per day. We have a specific aftercare process in place & you will receive a care bag with everything you need while recovering. Aftercare is one of the most important factors in healing, and the patient must take an active role in recovery and healing.

Once the incision is healed, it still needs to be protected from the sun. We recommend that patients use a silicone based scar gel WITH sunscreen. We offer Silagen with sunscreen, which is available in our office and on our website. It can be shipped to patients as needed.