Objectives To describe our technique of using reverse frontal bone graft for FOAR for patients with metopic or coronal synostosis.

Design Retrospective analysis of digital records for operation notes and radiological images.

Subjects Since April 2014, 16 patients underwent FOAR without using orbital bar.

Methods We plan a frontal bone graft using Marchac template and increase the angles on side by 1 cm. This graft is then reversed and supra orbital margins are drilled out. The orbital bar is then removed and drilled down to make bone dust which is then used to fill gaps on exposed dura. The reversed frontal graft is then placed in front and secured via absorbable sutures, plate and screws.

Results All 16 patients who underwent this technique have shown excellent cosmetic results with no complications or non healing. Removing orbital bar does not cause any cosmetic defect since orbital rims are drilled out in reverse frontal bone graft. The removed orbital bar provides an excellent source of bone dust to cover gaps on exposed dura.

Conclusions We present our technique of FOAR without using orbital bar, which is drilled down to bone dust to fill gaps. This has shown excellent cosmetic results so far with no complications. This addresses the issue of temporal thinning.