Unlike all other forms of this type of facial reduction, maximal brow bone reduction requires elimination of the frontal sinus to allow for its maximal effect. The putty is placed into the frontal sinus cavity up to the level of the surrounding reduced bone, smoothed and allowed to set. Using a hydroxyapatite cement formulation, the liquid and powder are mixed together to create a putty. A layer of Surgical and antibiotic powder (Gentamicin) is placed over the bone grafts. Each small piece is compacted onto each other for a tight bone graft. The removed bone flap is cut into small pieces where it is placed as as stacked bone graft into the frontal nasal duct. The lining is removed down into the nose. This is a very important step and one must search for all nooks and crannies of the frontal sinus, some of which are easy to overlook, to get all pieces of the mucosal lining. The sinus mucosa is then removed in its entirety. This also included the frontonasasl junction.
The surrounding perimeter of bone as well as the forehead above it and the tail of the brow bones to the sides are reduced as needed. The frontal sinus may or may not have midline bony partition. This exposes the entire frontal sinuses down into the nose.
The extreme brow bone reduction technique begins with first removing the bone flap through hardware removal and recutting the original osteotomy lines. While he had what many would consider a good result after the bone flap setback, she desired even further reduction. But a patient may not have confidence in a repeat of the same procedure and there is also the potential issue that the bone flap may not heal as well the second time as the first.Ĭase Study: This young male to female transgender patient had two prior attempts at brow bone reduction does through a hairline incision. It could be argued in these cases that the bone flap was not set back enough initially and a further attempt should be made to set it back even further. This is easy to see why it achieves more than what can be obtained by burring alone.īut there are patients who are not satisfied with the anterior table bone flap setback technique.
More significant reductions are achieved by taking off the anterior table of the frontal sinus, reshaping it and and then setting it back more into the sinus cavity. Minor reductions can be done by burring alone but the amount of retrusion obtained is limited by the thickness of the anterior table of bone over the frontal sinus. Of the two available brow bone reduction techniques the one similarity between them is that of frontal sinus preservation. While it is most commonly associated with facial feminization surgery, it is also done in men for very large brow bone protrusions that are often associated with a backward slanting forehead. Background: Brow bone reduction is a facial contouring procedure to reduce the supraorbital rim protrusion above the eyes.
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