Progressive craniofacial bone loss after cosmetic surgery at the forehead

Abstract

We present the case of a 59-year-old woman with a history of plastic surgery at the forehead who complained of progressive indentations at the frontal skull. CT and MR scans revealed significant bone thinning, presenting as lytic skull lesions, which progressed over a period of 3 years. Biopsies were obtained from the lytic lesions and histology showed fibrotic tissue, synthetic residue of previous cosmetic procedure, and no evidence of infection or neoplasm. Progressive cranial bone resorption places the patient at increased risk for cerebral injury. This case highlights a potential complication after cosmetic facial surgery, with bony resorption resulting in both skull deformation and increased risk for cerebral injury.

Frontal bone loss following coronal brow lift: A mimicker of head variant linear morphea

“…There has been only 1 previously reported case with nearly identical features with frontal bone indentations 3 years following coronal brow lift surgery, without evidence of ECDS , Parry-Romberg syndrome, or other metabolic, endocrine, neurologic, or infectious processes. 3 The pathogenesis of the associated bone loss is postulated to be secondary to surgical disruption of vascular and lymphatic circulation, leading to impaired tissue perfusion and localized bone resorption. 3 Although our case presented after a notable latency period of over 20 years, there have been reports of delayed onset of bone loss following other forms of facial cosmetic surgery.…”

“… 3 The pathogenesis of the associated bone loss is postulated to be secondary to surgical disruption of vascular and lymphatic circulation, leading to impaired tissue perfusion and localized bone resorption. 3 Although our case presented after a notable latency period of over 20 years, there have been reports of delayed onset of bone loss following other forms of facial cosmetic surgery. For example, patients undergoing silicone rubber chin implants were found to have concave erosions of the mandible underlying their implants with a delayed latency of up to 25 years.…”

“…Following multidisciplinary evaluation with rheumatology, endocrinology, neurology, neurosurgery, and radiology, mycophenolate mofetil was discontinued as the favored diagnosis was frontal bone loss secondary to coronal brow lift surgery, a rare complication previously reported in the literature. 3 Following the discontinuation of immunosuppressive therapy, the patient was started on bisphosphonate therapy. After 2 months, the patient reported significant improvement in her itching.…”