Tuesday, August 30, 2016

Ask the Doctor: Options for Teen's Forehead

CCA posts a monthly blog series called, "Ask the Doctor." You can submit your questions to Annie Reeves (areeves@ccakids.com) and we will ask Dr. Earl Gage of Kids' Plastic Surgery in St. Louis to answer them. Thanks Dr. Gage for helping spread information and resources for our cranio families!

Ask the Doctor

Earl Gage, MD, Kids Plastic Surgery, MercyChildren’s Hospital
Ask The Doctor
Earl Gage, MD
Kids Plastic Surgery, Mercy Children’s Hospital – St Louis, MO

Question: My daughter had bicoronal craniosynostosis (no known syndromes) corrected at 3 mos of age. She has no protruding brow bone over the eye, and where her eyebrows lie is very tight almost like a band is constructing that part of her forehead. Her surgeons from UC Davis have moved out of state, so we have not had follow up in many years. She is currently 15. Is there anything we can do to normalize this area of her face? The concern is primarily cosmetic, although her eyes are at risk without the normal brow bone protection. Is dermal filler an option? What kind of doctor should we see?

Answer:  The problem that you describe sounds like the orbital rim and forehead sit too far back. This can be a result of inadequate advancement at the time of the original surgery. It can just as easily be the result of regression or relapse following a well-done procedure, especially if the soft tissue was tight following an aggressive advancement.

Most of the time, when the brow and forehead sit too far back and the eyes are exposed, surgical correction by re-advancement of the forehead and brow are needed to normalize appearance and protect the eyes. Most of the time, this can be accomplished by doing a similar surgery to the one she had in infancy. The tightness of the skin may pose some challenges in moving the forehead forward, but this is usually manageable.

There are other options that can camouflage problems with forehead shape and position, such as prosthetic custom implants, dermal fillers or fat grafting. With custom implants, however, you need to have soft, healthy soft tissue in the area in order to minimize risk of implant complications or implant exposure. When the skin is scarred and tight, the risk in placing an implant may be too high. With dermal fillers and fat grafting, you should not expect to have dramatic changes. These modalities are really best when trying to smooth or improve small contour irregularities.

I cannot give you a specific recommendation for your daughter since I have not seen her and do not have a clear picture of her forehead position or the soft tissue challenges that may be present. However, based on your description, it sounds like surgery may be required to get the improvement she wants. You should see a craniofacial plastic surgeon in your area to get an in-person assessment and come up with a personalized plan for your daughter.

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