Males tend to have a horizontal ridge of bone running across the forehead just above
eyebrow level called the brow ridge or "brow bossing" while female foreheads tend to be
smoother, flatter and have less bossing, or bossing that project just below eyebrow level.
The outer segments of the bossing that the eyebrows sit on are called the "supraorbital rims".
The section of bossing between the eyebrows (the glabella) sits over a hollow area called the frontal sinus. Because the frontal sinus is hollow it can be more difficult to remove bossing there. If the bone over the frontal sinus is thick enough the bossing can be removed by simply shaving down the bone, however if the wall of bone is too thin it may not be possible to shave the bossing away completely without breaking through the wall into the frontal sinus. FFS surgeons have taken 3 main approaches to resolving this problem:
The 3 main approaches are:
Type 1: Shaving
Type 2: Shaving and closing
Shaving and closing the small perforations in the anterior wall of the frontal sinus with little flat pieces of bone (bone chips), sometimes fixed with mini screws.
Type 3: My preferred method
- sliding osteotomy (cutting) of the whole anterior wall of the frontal sinus including the supra-orbital rim.
- remodelling of the anterior 'wing'-shaped bone plate.
- repositioning of the bone plate in a posterior position (endorotation of the lower part)
- fixation with mini titanium screws.
- remodelling of the lateral part of the supra-orbital rim, also at the inside of the superior part of the orbit in order to open the view.