My forehead feels hard and looks unnatural after an implant. Would removal help?
As time passes after forehead implant surgery, some people consider removal because "my forehead feels too hard," "it looks obvious that I have an implant,"
"my forehead looks too rounded and unnatural," or "I think I can feel the edge of the implant."
The main question is often: "Can my forehead look natural again if the implant is removed?"
If the current unnatural appearance is directly related to excessive volume or contour created by the implant,
or to palpable edges, removal may eliminate or reduce that cause. However, it cannot be guaranteed that the forehead's feel and shape will return completely to their preoperative state.
The available medical literature on forehead implants primarily addresses materials, surgical techniques, complications, and revision surgery. Studies directly comparing hardness or tactile changes before and after implant removal are limited.
The important first step is therefore not simply deciding whether removal will help,
but identifying why the forehead currently feels hard and unnatural.
A firm forehead implant does not always mean something is wrong
Various synthetic materials, including silicone and ePTFE (expanded polytetrafluoroethylene), have been used for forehead augmentation.
The forehead implant literature describes augmentation with silicone and ePTFE, whose characteristics and interactions with tissues may differ.
The cause of a firm forehead should therefore not be determined by touch alone.
The implant itself, its thickness and shape, and the condition of the overlying soft tissues can all affect how the forehead feels.
In particular, avoid immediately equating a hard forehead with severe capsule formation.
Literature on silicone forehead implants describes implant designs intended to reduce implant mobility and capsule contraction.
Capsule-related tissue reactions are therefore a consideration. This does not mean that capsular contracture can be diagnosed from hardness alone.
It is important to assess the implant and surrounding tissues together rather than concluding from touch alone that a capsule or adhesions are responsible.
Hardness and an unnatural shape should be assessed separately
When someone wants a forehead implant removed, the reasons can broadly be divided into two categories: how it feels and how it looks.
A firm forehead, a palpable implant or edge, an overly prominent forehead, and a curve that does not suit the face may represent different problems.
The forehead augmentation literature has reported revision cases prompted by excessive volume or visible or palpable edges.
In a study of 516 patients who underwent forehead augmentation with MMA (methyl methacrylate), 28 patients (5.4%) underwent revision because of an undesired postoperative appearance.
The authors also explained that the edges of the augmentation material should be sufficiently thinned so they are neither visible nor palpable.
However, this study involved MMA augmentation, not silicone implants.
The 5.4% figure should therefore not be applied as a revision rate for silicone forehead implants.
The relevant lesson is that assessing an unnatural result after forehead augmentation requires consideration of volume, contour, and palpable edges as well as how the forehead feels.
What might change after forehead implant removal?
The most important factor is the cause of the current problem.
For example, if the forehead looks too prominent mainly because of the added volume of the implant, removing it will also reduce that volume.
If the implant's edge or shape causes the unnatural appearance, removal may eliminate or reduce that cause.
Changes in feel require a different approach. There are not enough studies directly measuring how much softer the forehead becomes after removal,
so it is inappropriate to promise that removal will necessarily make the forehead soft. The feel after removal may depend not only on the implant's material and shape,
but also on the surrounding soft tissues, including the overlying skin and subcutaneous tissue.
It is therefore important to distinguish changes in appearance from changes in feel during a removal consultation.
Will removal completely restore the forehead to its preoperative state?
This is another common question. Removing the implant eliminates the additional forehead volume it provided.
If it was originally inserted because the forehead was flat or hollow, removal may reveal the original bony contour again, making the forehead feel flatter or less prominent than before removal.
However, removal should not be understood as 100% restoration of the preoperative forehead. Soft tissue condition after insertion and subsequent removal can differ between individuals.
The current medical literature does not allow a uniform numerical prediction of how closely the original shape and feel will be restored after removal.
Before deciding on removal, therefore, consider not only whether you want the implant gone, but also what forehead volume and shape you want afterward.
Does the capsule need to be removed too?
An implanted material can trigger a response in the surrounding tissues.
As described above, forehead implant literature considers reducing capsule contraction when discussing silicone implant design.
This does not establish a general rule that the entire capsule must always be removed with a forehead implant.
The currently available evidence does not support a standard principle requiring complete capsulectomy for every forehead implant removal patient.
How extensively to address surrounding tissues, including the capsule, should be decided individually based on implant material, current tissue condition, and actual operative findings.
Hardness should not automatically be equated with a capsule problem requiring complete capsule removal.
Pain, swelling, or warmth should be distinguished from a purely cosmetic concern
A forehead that simply feels hard or has an unsatisfactory shape should be considered separately from one with accompanying symptoms.
Complications associated with facial implants, including infection and the need for implant removal, have been reported,
and a 2019 systematic review and meta-analysis of 17 studies involving 2,100 patients found that complication patterns may vary with implant material and placement site.
The study included the frontal bone, or forehead, region.
Pain, swelling, warmth, redness, discharge, or a sudden change in forehead shape should therefore not be dismissed as merely a concern about feel or appearance.
New or progressively worsening symptoms in particular warrant clinical assessment of the implant and surrounding tissues.
What should be checked before forehead implant removal?
First, it is important to obtain information about the previous surgery where possible.
Knowing the implant material, when surgery was performed, and whether there have been revisions can help the consultation.
An in-person examination can assess the following:
- Overall forehead contour
- The suspected extent and edges of the implant
- Differences between sides
- How the forehead feels
- The condition of the skin and soft tissues
- Accompanying symptoms such as pain, swelling, or warmth
Additional testing may be considered when needed to assess the current condition.
Frequently asked questions
Q. Does a hard forehead implant mean there is a problem?
A. Not necessarily. Implant material, shape, thickness, and overlying soft tissues can all influence how the forehead feels.
Hardness alone cannot establish a capsule problem or another complication.
Q. Will my forehead become soft after implant removal?
A. If the implant itself contributes to the firmness, the feel may change after removal.
However, direct studies comparing feel before and after forehead implant removal are limited, so the degree of softening cannot be predicted uniformly for all patients.
Q. Will my face return to its original appearance after forehead implant removal?
A. The added volume from the implant will be removed. However, the resulting shape and feel may depend on the existing bone structure and current soft tissue condition, so an exact return to the preoperative state cannot be guaranteed.
Q. Can the implant be removed if my forehead looks too rounded?
A. Removal may be considered if the implant is the main cause of the excessive volume.
Because the volume it provides will disappear, the surgical plan should also take into account the forehead shape you want after removal.
Q. Must an implant be removed if its edge is palpable?
A. No. Rather than deciding on removal from palpability alone, the effect on appearance and feel and the presence of other abnormal findings should be assessed first.
Q. Must the entire capsule be removed with a forehead implant?
A. No standard principle requiring complete capsule removal in every patient has been established. The necessary extent of treatment should be individualized after assessing the implant and surrounding tissues.
Q. Can an old forehead implant be removed?
A. Yes. However, the removal method and difficulty can vary with the implant's material, shape, fixation, location, and current surrounding tissues, so planning requires direct assessment.
Identify the cause of hardness and an unnatural appearance before asking whether removal will help
Not every patient whose forehead feels hard or unnatural after an implant has the same problem.
First distinguish whether the concern involves ① volume created by the implant, ② a palpable implant or edge, ③ a contour that differs from the desired appearance, ④ a change in feel as the main problem, ⑤ the influence of surrounding soft tissues, or ⑥ accompanying pain, swelling, warmth, or other symptoms.
If excessive implant volume, contour, or palpable edges are the main cause, removal may eliminate or reduce that cause. However, current evidence cannot uniformly predict how much softer the forehead will become or how closely it will return to its preoperative shape.
If you are considering removal, surgical planning should assess the cause of the unnatural appearance, the type of implant, the surrounding tissues, and your desired forehead shape afterward, rather than focusing only on whether removal will look natural.
If you are considering forehead implant removal, please call 02-545-3700 or contact 'UVOM Plastic Surgery' on KakaoTalk.