The Process of a Fronto-Orbital Advancement Procedure
Because a blood transfusion may be used during the operation, some families choose to donate blood for the operation before the surgery.
Once the patient is asleep, many monitoring devices will be placed to ensure safety throughout the operation. An opening is made on the top of the scalp from one side of the ear to the other. In most cases, the entire operation can be performed using only a scalp incision called a coronal incision. This opening may take the form of a wavy line to help hide the scar within the hair.
During the procedure, the forehead bone will be separated from the skull first. Then a band of bone is removed from the brow area. This includes the top of the eye sockets and parts of the temple. Once the forehead and brow section are removed, the bones are molded by the craniofacial surgeon into a shape that gives a more natural contour to the face. After the bones have been reshaped, they are returned to the skull in a forward position to create more space for the brain and improve facial appearance. The bones are then secured into place with dissolvable plates, screws and sutures. Occasionally metal may be used to keep the bones secured, but this will be decided by the surgeon. Once the bones have been secured, the scalp is closed. A small drainage tube may be placed under the scalp skin. This drain exits by the ear into a collection bulb, which the patient will be able to see during recovery.
Post-Op & Recovery
After the surgery you will see a bandage around the head. Fluid may drain from the scalp incision. Most of this fluid will stop draining after a couple of days. The patient’s brow and forehead shape – and position – will have noticeably improved. These bones are commonly placed in a forward position that makes brow and forehead appear “strong” or slightly overcorrected. This is a normal part of the reconstructive plan to account for growth.
Swelling & Discomfort
It is important to note, this surgery does produce dramatic swelling around the eyes. It is usually not bad at first, but increases rapidly over two days. Commonly, the eyes swell shut over the course of those two days and then slowly resolve over several days. Most of the discomfort experienced after the surgery will be from the swelling of the face rather than the pain from the surgery itself and medicine will be given to help with any discomfort. Cool compresses to the face and sleeping with the face raised above the heart will also help decrease the swelling. Bruising around the eyes can also develop, but this will resolve over the course of approximately 2 weeks.