Brow Bone Reduction Complications
If you’re considering brow bone reduction surgery, you probably have a lot of questions about what could go wrong. Like any surgical procedure, brow bone reduction comes with its share of risks. Some complications are minor and manageable, while others, though rare, can be more serious. Knowing what to expect ahead of time can help you feel more confident in your decision and better prepared for recovery.
Whether you’re just starting to research this procedure or have already scheduled your surgery, it’s important to be informed. In this guide, I’ll walk you through both common and rare complications so you can understand what to look out for and how to minimize your risks. Let’s dive in!
What Is Brow Bone Reduction?
Brow bone reduction is a surgical procedure designed to reshape the forehead by reducing the prominence of the frontal bone. The technique used depends on the thickness of the bone and whether the frontal sinus is involved. In cases where the bone is thick enough, it can simply be shaved down. However, when the frontal sinus extends into the brow ridge, the procedure becomes more complex and may require removing and reshaping a section of bone before securing it back in place.
This surgery is typically performed under general anesthesia and may be done in conjunction with other facial feminization or facial contouring procedures. Recovery involves several weeks of swelling and bruising, but most patients return to normal activities within a few weeks.
Less Severe Potential Complications of Brow Bone Reduction
1. Bleeding and Bruising
Because the forehead has a rich blood supply, some degree of bruising and swelling is expected after surgery. It is expected that minor ozzing can occur from the incision in the first 24 hours after surgery. Rarely, bleeding can be severe enough to require coming into the office to cauterize any bleeding vessels. If post-operative bleeding is not addressed, a hematoma (a localized collection of blood) may form, which could require drainage.
You can have a higher risk of bleeding if you:
- Have a history of a bleeding disorder
- Have uncontrolled high blood pressure
- Do any strenuous activity too soon
Dr. Saxon has you wear a compressive dressing around your forehead and scalp after surgery, which helps prevent fluid collections as well as bleeding.
2. Infection
Although rare, infection remains a potential complication like any other surgical procedure. A brow bone reduction involves working in the frontal sinus, which contains bacteria and cannot be sterilized prior to surgery unlike the skin. For this reason, Dr. Saxon will give you antibiotics to help prevent any infection.
An infection can look like localized redness, swelling, warmth, and discharge. If left untreated, infections of the bone (osteomyelitis) can occur and may require long-term antibiotic therapy or even additional surgery.
3. Scarring
The incision for brow bone reduction is typically made along the hairline or across the top of the head (coronal incision), or within the hairline (pretricheal incision). Dr. Saxon uses several techniques to help the incision heal with a minimal scar. She uses deep sutures in a tissue layer that takes tension off of the incision. Platelet-rich fibrin is also injected to help mature collagen within the scar more quickly as well as encourage new hair growth through the incision. Specific wound care with a hypochlorous acid spray can also help to reduce inflammation and improve overall scar healing.
While efforts are made to minimize visible scarring, some individuals may develop hypertrophic or wide scars, particularly if they have a genetic predisposition to abnormal scar formation. Scars tend to fade over time but may require laser treatment, microneedling, steroid injection, or micropigmentation.
4. Seroma (Fluid Collection)
A seroma occurs when fluid accumulates under the skin after surgery, leading to swelling and discomfort. This fluid buildup may resolve on its own, but in some cases, drainage is necessary. Seromas can increase the risk of infection if left untreated, and they may prolong the healing process. The compressive wrap you have on after surgery is typically enough to prevent seroma formation.
5. Shock Hair Loss
Temporary hair loss, also known as telogen effluvium, can occur after brow bone reduction surgery or any other stress to the body. When this happens, the hair follicles around the incision site as well as farther back on the scalp temporarily go into a dormant phase, leading to thinning or bald patches. Hair usually grows back after shock hair loss but can take up to a year.
Some circumstances where we find shock hair loss to be more common include:
- High stress or anxiety around the time of surgical recovery
- Low calorie and protein intake
- Pregnancy soon after surgery
You can take vitamins like Nutrafol around the time of surgery to support the hair follicles. Dr. Saxon also recommends supplementing meals with a protein shake starting 2 weeks before surgery and continuing up to 1 month after surgery to help minimize shock hair loss related to nutrition.
6. Numbness
There are two nerves in the area where a brow bone reduction surgery is done called the supraorbital and supratrochlear nerves. These nerves can be damaged during a brow bone reduction, causing permanent numbness to the forehead and scalp. There are specific techniques that allow the nerves to be pushed out of the way to prevent injury, so permanent numbness is extremely rare.
More commonly, there is temporary numbness due to the tiny nerve endings that get disrupted in making the incision for your surgery. While it can take at least a year to fully come back, sensation is generally fully restored over time.
Rare but Serious Complications of Brow Bone Reduction
While most complications of brow bone reduction are well-documented, some potential risks remain theoretical due to the anatomy of the area. These include conditions that, while possible in theory, have not been reported in the medical literature. Understanding these rare risks is still important when considering surgery.
7. Mucocele (Frontal Sinus Complications)
Brow bone reduction requires reconstruction of the frontal sinus which is an air-filled space within the bone of the forehead. The frontal sinus is lined by a mucous-secreting layer and drains into the nose called the mucosa. We know from management of frontal sinus fractures after trauma that if any of the mucosa gets trapped within bone fragments, it can form a cyst that can slowly grow and displace and remodel the bone around it – almost like a benign tumor.
Mucoceles can take decades to grow, and can be a long-term complication years after brow bone reduction surgery. If caught in the early stages, mucoceles can be treated with endoscopic sinus surgery to drain the mucous from the cyst.
8. Cerebrospinal Fluid (CSF) Leak
A CSF leak occurs when the layer around the brain, called the dura, is inadvertently punctured. To my knowledge, there have been no case reports of CSF leak specifically after brow bone reduction, but it remains a potential risk.
The brain and dura are protected from the frontal sinus by a layer of bone. If the bone is very thin or brittle due to age or osteoporosis, the process of removing the front wall of the frontal sinus for reconstruction could, in theory, cause a small crack in the bone which could then cause a CSF or pneumocephalus.
If a CSF leak occurs after sinus or forehead surgery, it usually causes constant clear drainage in the nose that tastes salty. It can resolve on it’s own with conservative observation, but it may require an additional surgery to patch the area and prevent further leakage.
9. Pneumocephalus (Air in the Skull)
This exceedingly rare complication occurs when air becomes trapped inside the skull, leading to neurological symptoms such as headaches, dizziness, and confusion. While seen in some neurosurgical procedures, there are no reported cases of pneumocephalus occurring after brow bone reduction.
10. Osteomyelitis (Bone Infection)
A single case report of osteomyelitis after brow bone reduction was first introduced at the American Academy of Facial Plastic and Reconstructive Surgery Annual Meeting and has now been published in the literature.
Osteomyelitis is an infection in the bone itself which can be very difficult to treat. The patient in the case report ultimately required an extensive surgery to close off the frontal sinus with fat (frontal sinus obliteration).
Read more about this extremely rare complication here:
11. Double Vision (Diplopia)
A case series from Stanford University was published where two patients presented with double vision after brow bone reduction surgery from damage to the trochlea. The trochlea is attached to the inner wall of the eye socket and acts as a pulley for the superior oblique muscle allowing it to move the eye down and outward.
The patients in this case series had superior oblique palsy causing double vision.
This rare complication of brow bone reduction is presumably the result of extensive elevation of the soft tissue in the eye socket to allow room for cuts using a cutting guide. This as well as other rare complicatiosn of brow bone reduction can be attributed to using these more extensive techniques that are much more aggressive. For this reason, I feel that relying on CT scans and cutting guides to contour the bone is not needed and can cause far more complications than using more conservative approaches.
Read more here:
Final Thoughts
Brow bone reduction can achieve dramatic facial contouring results, but like any surgical procedure, it carries risks. While most complications are mild and manageable, it’s important to be informed about potential issues—both common and rare.
