The forehead is one of the most important facial features that reveal the gender of the person. A male forehead is significantly different from that of a female. A smooth and even surface is the characteristic of the female forehead. A male forehead has a more projected forehead than a female forehead. The projection is composed of supraorbital rim located just beneath and above the eyebrow. A male forehead is also taller and larger than a female forehead.
Douglas Ousterhout has described 4 types of forehead contouring. Type 1 and type III are the most common types used at our centre. A Type III forehead Bone Reconstruction involves the removal of a section of bone that covers the frontal sinus ( outer table) and shaving of the bone from the surrounding areas. The bone thickness that covers the frontal sinus and the size of the sinus are the main factors that are needed to be assessed while determining the best-suited approach.
An incision is made along the hairline of the patient. This gives access to the patient’s forehead. The periosteal flap is pulled back in order to expose the bone underneath. Exact size, shape, and location of the frontal sinus are determined through the process called Transillumination. When the thickness of the bone is determined, bone shaving is done.
In type I forehead reconstruction, surgeon grinds the frontal and orbital rims using a bone contouring burr. This helps to flatten the supra-orbital prominence and also to reduce the heavy orbital bone. This type of forehead reconstruction can be used in those having small or absent frontal sinus.
In type III reconstruction, the outer table of frontal bone is cut along the lines marked and is removed from its position. It is reshaped on a work station and then is placed back on the forehead. Titanium screws or titanium mesh are used to keep it in place.
Forehead bone reconstruction is more invasive than forehead contouring, which is why there is a risk of frontal sinus osteonecrosis or bone tissue death. However, it is uncommon but can occur in the body which fails to re-establish sufficient blood circulation to the bone. In the technique used by Dr Parag Telang, the forehead reconstruction is covered with a vascular flap from the scalp called as pericranial flap. This ensures good blood supply to the frontal bone and excellent healing. In more than 250 FFS forehead reconstruction surgeries done at our centre, we have not encountered any problems with healing of the forehead area.
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