While more complex and time-consuming than fat grafting by injection, direct placement of either a pre-made stock or custom-prepared silicone implant requires only a single operation to yield a permanent result.
The implant is used to convert an overly flat or sloped bony contour to more of a convexity, thus adding an element of depth to the upper third of the face. Digital imaging can help the patient and surgeon decide on the desired height, width, and thickness of the augmentation.
Custom-made silicone implants are fabricated from facial moulage kits using supplies found in most dental offices. A plaster mold of the patient's forehead is first made, after which a wax template is sculpted over the plaster. Once the patient "tries on" and approves the template, the actual implant is carved from a block of soft silicone using the template as a guide. The implant's edges are tapered and notched to hide them and allow better conformation to the curved surface of the bone. Several office visits are required to complete this process, after which the implant is sterilized for use in later surgery.
Three small incisions hidden in the hair of the upper scalp and temple are made to allow dissection of the forehead muscle off of the bone. The implant is rolled up and introduced through one of the temple incisions. Once in place, it is unfurled and better positioned. It can span the entire width and breadth of the forehead down to the eye sockets or be made smaller to address localized depressions.
Activity in the forehead's large and powerful frontalis muscle can sometimes lead to later displacement. Putting the implant below the bone's lining (periosteum) requires more dissection but increases stability.
Initial recovery takes about two weeks, while full healing takes up to six months.