Introduction : The fusion of the metopic suture, produces an aesthetic alteration of the anterior aspect of the frontal bone. Many surgical techniques have been described for its solution; we present our experience and some variations of the traditionals methods.

Methods : Using the Witaker categorization grades III and IV underwent surgery; presurgical assessment was done by 3-D tomography and the use of sterioliothographyc models in some of cases. Z-form incision was made, frontal bone flap was taken and a variation of osteotomies was performed individualized for each case with or without modification of the supraorbital bar.

Results : Ten patients diagnosed of trigonocephaly underwent surgery since 2005–2012, two female and eight male, the mean age of surgery was 18 months. In five patients rotation in 180° was done, one patient used a distractor, one advance in monoblock, and 3 fronto-orbtial advance plus osteoplasty. We had one surgical infection, one minimal skin retraction and one reoperation due insufficient results.

Conclusions : Trigonocephaly is a great surgical challenge because each patient has specific aesthetic details that must be considered before the surgical process, good assessment and planning of the process should be done. The individualized design of the surgical method is mandatory.