Neanderthal Forehead
Neanderthal Forehead
Neanderthal Forehead
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Effect of heredity on aSome research has shown that high levels of growth hormone and male sex hormone (testosterone) can lead to a prominent forehead
In some cases, a forehead prominence may be caused by a tumor in the forehead. The prevalence of these tumors is low and they are not considered a major cause of a prominent forehead. Unlike a forehead prominence, which is always located in the lower part of the forehead and below the eyebrows, the location of forehead tumors is variable and is usually unilateral (and asymmetrical).
In some individuals, the bony part of the lower forehead protrudes forward due to the growth of the frontal sinus. If this prominence is excessive, it can give the person a harsh and angry appearance. Additionally, the prominence of this area reduces the angle between the nose and the forehead in a side profile view. Many people who have this prominence also have a bony prominence between the eyebrows and a prominence of the orbital rim, which together can make the eyes appear deeper set.Is there an alternative method to correct the Neanderthal appearance or forehead protrusion.
Neanderthal protrusion can be reduced only through a surgical method. However, gel injection, fat injection, etc., in depressed areas can be suggested in some people with upper forehead depression (that definitely shows more protrusion) to correct part of this inconsistency. This technique causes the protrusions to relatively and partially seem less visible due to vision error.
It is important to note that not all protrusions observed in the lower forehead are due to hard tissue (bone). In some individuals, the soft tissue may have a significant thickness. To differentiate between the two, we can palpate the bony prominence by examining the individual. Often, people have a combination of bony and soft tissue prominence simultaneously.
To correct the bony protrusion of the lower forehead, there are various methods that the surgeon must choose based on the degree of protrusion. Performing a detailed CT scan before surgery helps the surgeon measure the thickness of the bone and the degree of protrusion, and identify any signs of sinusitis in the frontal sinus. With this method, the most accurate type of surgery is selected, and if necessary, the frontal sinus disease is also treated simultaneously.
Sometimes, due to excessive growth of the frontal bone, the upper part of the forehead grows forward and extends further than the lower parts and the brow bone. This condition is more common in women and, unlike the protrusion of the lower part of the forehead, is not related to the growth of the frontal sinuses.
The presence of this type of protrusion disrupts the proportion of the upper facial features and often creates a high forehead appearance. In individuals with a receding hairline, the severity of the protrusion is more noticeable.
A combination of bone shaving and forehead shortening is necessary to correct this protrusion.
This is a direct translation and refers to a horn-like growth on the forehead.
In forehead contouring surgery, the term “forehead horn” refers to a bony protrusion in the upper part of the forehead, which is usually seen bilaterally as shown in the image below. This condition should not be confused with forehead masses (tumors and masses on the forehead are usually unilateral).
In some individuals, the bone between the lateral protrusions is also prominent, creating a “dumbbell-shaped” appearance.
A mild form of this protrusion is commonly seen, and most people do not have a problem with its appearance, but severe cases of this type of protrusion can have unpleasant effects on facial aesthetics. This imbalance can be corrected using open surgery and bone shaving.
These forehead protrusions are normal and should not be confused with bone tumors in the forehead area. Therefore, the only reason for removing these protrusions is for aesthetic purposes.
Sometimes, benign bone tumors can also cause a protrusion in this area of the forehead, which a skilled physician can easily differentiate from the normal protrusions. In most cases, removing these tumors is also the only treatment.
As an alternative method for some individuals, the appearance of forehead horns can be corrected through fat injections, filler injections, or bone cement. This approach is particularly beneficial for those whose facial beauty is enhanced by a more prominent
forehead.
In some individuals, the brow bone (the bone forming the edge of the eye socket) grows excessively, causing the prominence to adversely affect the position of the eyebrow, the shape of the eye, and the upper eyelid. This condition can lead to puffy upper eyelids or unevenness around the eyebrow. In some cases, asymmetrical growth of this prominence can result in asymmetrical eyes. Most people seeking upper eyelid rejuvenation do not consider this issue, and in blepharoplasty (upper eyelid surgery), it is often overlooked. Therefore, if a person still complains of remaining puffiness in the eyelid after upper eyelid surgery, one of the reasons for the remaining puffiness may be a prominent brow bone.
Note: Most people who undergo facial feminization surgery require brow bone reduction.
This prominence can be corrected by shaving the bone. Interestingly, most people who have a prominent frontal sinus also have some degree of brow bone prominence, which can be corrected during surgery.
For individuals who desire a more masculine appearance (especially those transitioning from female to male), facial masculinization surgery can be performed. It is known that in males, facial bones grow more than in females, with the brow bone, cheekbone, and lower jaw showing the most significant differences. Using custom-designed implants, the area below the eyebrow and the lower forehead can be made more prominent. This surgery has a relatively small following in Iran, and more importantly, non-surgical methods (such as filler injections) can be offered as an alternative to those seeking facial masculinization. An example of an implant design for individuals seeking facial masculinization is shown. As can be seen, the lower part of the forehead is made more prominent using the custom-designed implant.
Sometimes, the proportions of the forehead are out of balance with the rest of the facial features, resulting in a high or wide forehead. By reducing the length and width of the forehead, we can minimize its size and thus create a better proportion with the other facial features. Forehead Shortening: The height of the forehead, or the distance from the hairline to the eyebrows (the vertical portion), may increase genetically or due to hair loss with age, leading to an unattractive appearance. (Typically, a forehead is considered high if it is more than 6.5 centimeters. Another criterion for evaluating forehead height is the proportion of the forehead to the other facial features, meaning that the forehead should not be more than 1/3 of the facial height.) Changes in this dimension of the forehead are usually due to changes in soft tissue, and it can be corrected with surgery on the soft tissue. This type of surgery is called forehead shortening surgery. In most people, we can reduce the height of the forehead by 2 to 3 centimeters through surgery. Forehead Narrowing: Sometimes, the width of the forehead is greater than normal due to excessive bone growth. In this situation, we can reduce the width of the forehead to some extent by shaving the bone. In some individuals, due to an excessive distance between the hairline at the temples and the end of the eyebrows, the width of the forehead (the upper width of the face) appears wider than normal.
After Trauma and Accidents:
In some individuals, previous traumas can cause deformities in the forehead. Since the forehead is always visible, these deformities can have a negative impact on a person’s appearance. To correct these deformities, it is necessary to determine whether the defect is related to soft tissue or hard tissue. As seen in the image below, soft tissue defects usually manifest as scars.
In forehead fractures, the issue is more complex than simply repairing the soft tissue. Sometimes, bone shaving, bone grafting, the use of implants, or the use of bone cement is necessary to correct the bone defect.
In this method, we access the prominent area through a midline forehead incision. Fortunately, we can perform the surgery while preserving the nerve branches. (We know that in a coronal incision or a complete scalp incision, all terminal nerve branches are cut).
This method can be used for grades 1 and 2 prominences and in some cases can be performed endoscopically. The amount of bone shaved depends on the thickness of the sinus wall. Prominences suitable for endoscopic bone shaving should have a bone wall thickness greater than 4 millimeters.
Note: Bone shaving alone can have two undesirable outcomes. First, it can perforate the anterior wall of the sinus, allowing the sinus to protrude under the skin. Second, shaving the anterior part of the sinus wall does not correct the nasofrontal angle.
In individuals undergoing facial feminization surgery as part of a gender transition from male to female, one of the important steps in feminization is correcting the lower forehead prominence. It is best to use the standard method with an incision in front of the hair for these individuals (even if they are candidates for endoscopic bone shaving) so that we can not only shape the prominence better but also shorten the forehead and change the nasofrontal angle.
In this method, by injecting fat or filler into the area above the prominence, the prominence can be hidden. Another form of this alternative method is the use of custom-designed prostheses for the hollow area above the prominence. Obviously, this method is recommended for milder prominences and cannot affect the correction of eye sockets.
In individuals with very large prominences where even after standard surgery some prominence remains, or in individuals where the sinus wall has been destroyed due to excessive bone shaving in a previous surgery, a very useful method is to remove the bony wall and fill the sinus cavity with HA cement or fat graft.
Dr. Ousterhout, in a study conducted between 1980 and 1990, divided forehead prominence into three main categories:
Grade 1: Mild prominence of the frontal bone and orbital rim, and bone shaving does not cause any problems for the frontal sinus. (In these individuals, only shaving the prominent bone can be performed.)
Grade 2: More pronounced prominence and may be corrected with shaving alone, but the sinus wall becomes very thin. Also, for the concavity of the area above the prominence, we can use filler injection or cement. (In these individuals, shaving the prominent bone with or without displacement of the sinus wall can be performed, but in any case, the sinus wall becomes thin.)
Grade 3: The sinus prominence is so great that correcting the prominence without displacing the sinus wall and changing its shape is not possible. In this group, the prominence of the glabellar area causes the nasolabial angle to become more acute, and during surgery, this angle is corrected by shaving the lower part of the prominence. Cement or filler may be needed to correct the concavities above the forehead.
The standard method for correcting forehead prominence is open surgery, in which we can shave, remove, reshape, and reposition the protruding bone. This approach is almost always used for grade 3 prominences.
It is expected that with forehead prominence correction surgery, which is a modern method for shaving the bony prominences of the forehead, the prominences caused by the growth of the frontal sinus wall will be reduced or eliminated. Although in this brief article we are only focusing on the cosmetic aspect of this surgery, based on my experience from numerous surgeries that I have personally performed, I have noticed that after surgery, chronic headaches in the forehead area of individuals with forehead prominence have been significantly alleviated or even eliminated.
● Inside the hair:
The incision is made in a straight line, extending from one ear to the other. This method allows for lifting the forehead by approximately 5 to 10 millimeters. This procedure is not recommended for individuals with high foreheads.
● Hairline:
The incision is made in a zigzag pattern at the front of the forehead. It’s important to note that due to the delicacy required to conceal the stitches, the surgery time may increase by about 30 minutes. Additionally, the forehead may be shortened by 5 to 10 millimeters. This method is recommended for individuals with high foreheads.
Some people, while complaining about a prominent forehead, also complain about a high forehead and drooping eyebrows. To achieve better results in correcting a prominent forehead surgery, it is possible to shorten the forehead along with correcting the prominence by making an incision along the hairline. At the same time, a forehead and eyebrow lift can be performed to create a more aesthetically pleasing appearance.
Although surgery to correct a prominent or Neanderthal forehead is safe, like any other surgery, it can have complications. Each of these complications can be prevented or treated using specific methods.
These complications include bruising, pain, itching or numbness of the forehead skin, swelling, hair loss, destruction of hair follicles, and the remaining scar of surgery.
On the other hand, increased pressure inside the sinuses can cause headaches in some people. The prevalence of sinusitis is higher in people with prominent foreheads than in the general population. However, not all people with this problem experience headaches, and there is still no study that links the cause of these headaches to excessive sinus growth.
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Given the nature of the surgery and the post-operative conditions, it is essential to be aware of the exact post-surgery care procedures. This will allow you to return to your normal life as quickly as possible and avoid specific complications arising from the surgery. To this end, immediate post-surgery support will be provided to you through the sending of care files and follow-up phone calls.
● Individuals below the age of puberty as their bones have not yet fully developed.
● Individuals with inconspicuous protrusions.
● Individuals seeking surgery to correct sinusitis.
● Individuals seeking surgery to correct asymmetry.
● Individuals seeking surgery to reduce headaches.
The main goal is to create the desired changes for the patient, aiming to correct the imperfection and establish harmony between the forehead and other facial features. Considering this, the changes required for each patient are different from others, and therefore the location of the surgical incision and the method of performing it is different for each patient. Depending on the imperfections present in the forehead and the patient’s desire, the surgical method is determined in a consultation before the surgery.
No. An important point to consider is the use of non-surgical methods for forehead contouring. In some individuals, the same desired results can be achieved through non-surgical procedures. For example, in a person with a slight prominence in the lower forehead, a smooth and beautiful forehead can be created by injecting fillers or fat into the surrounding areas.
Yes, but due to the high level of precision required and to ensure the most effective and desired outcome, it is recommended to perform this procedure concurrently with an open forehead lift.
Yes, shaving the brow bone through upper eyelid surgery is possible, but to a very limited extent.
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Do not choose this surgery solely because of headaches. Although we have observed that many individuals experiencing sinus headaches in the frontal area have experienced a reduction or complete elimination of these headaches following prominent forehead surgery, it is scientifically incorrect to perform this surgery for the sole purpose of relieving headaches.
Although this surgery can
address the issue of frontal sinusitis, given the existence of endoscopic sinus surgery, it is more logical to treat sinusitis with a less invasive method. This surgery is only recommended as a treatment for sinusitis for individuals who, in addition to frontal sinusitis, also have a prominent forehead.
It can be said that when we modify the sinus walls, we can simultaneously correct the narrowing of the sinus opening. With this action, we expect that not only will the likelihood of sinusitis not increase, but we also anticipate that even if a person has previously suffered from recurrent sinusitis in the frontal sinus area, this method could decrease the probability of sinusitis, as the sinus openings will be widened.
This surgery will not cause any positive or negative changes to nasal congestion. If a person has nasal congestion, they may need procedures such as a deviated septum correction or polyp removal.
There may be asymmetries in the prominences on both sides of the forehead, which are related to the growth of the sinus walls. In most cases, these asymmetries can be partially (but not completely) corrected.
The frontal sinus is not present in the upper parts of the forehead, and these prominences are usually caused by the shape of the skull. Correcting them requires a different surgical approach.
The location of the incision varies depending on the length of the forehead. If the forehead is short, the incision is made within the hairline. If the forehead is long, the incision is made along the hairline.
Forehead wrinkles will be slightly reduced.
It is possible to correct a prominent forehead after the age of 18. However, Dr. Biat recommends performing this surgery after the age of 20 so that the individual can make a more rational and informed decision.
Yes, but because it requires a high degree of precision and may not yield the desired effective result, it is recommended to perform it simultaneously with an open forehead lift.
Correction of a prominent forehead can only be done through an open approach, where the incision is made within the hairline or along the hairline, depending on the height of the forehead and the patient’s preference.
