Forehead Contouring / Forehead Shaving

Forehead Contouring, Brow Bossing Contouring, Brow Reduction:

          These procedures involve altering the shape and contours of the forehead and brow bones to better match typical female features.

          1. Forehead contouring is a surgical procedure that reduces the width and height of the forehead to create a more curved, rounded appearance. This can be done by shaving down the bone or by using a combination of bone-shaving and soft-tissue reshaping techniques.

          2. Brow bossing contouring is a procedure that targets the protruding brow bones (also known as brow bossing) that are commonly found in men. It can reduce the size and prominence of the brow bones to create a more natural arch to the eyebrows.

          3. Brow reduction is a procedure that addresses low-set or heavy eyebrows, which make them appear more masculine. It can be done by removing excess skin, fat, or bone to reposition the brows to a more feminine location. 

  

Figure 1: Forehead Contouring

Forehead Contouring: 

          Forehead contouring is a critical procedure for enhancing femininity and reducing masculinity of the upper facial features. Three main categories of forehead contouring are unique to the individual. The type of procedure needed can only be determined through a CT scan.

          Procedure Type 1: This procedure involves implanting an implant in the mid-forehead area to improve the forehead's curve. Implant materials can include injectable material, fat grafts, or permanent implants.

          Procedure Type 2: This procedure involves shaving down the bone above the eye and frontal sinus areas using a contouring bur. The bone can be reduced by approximately 3-5 mm, and the incision is made behind the hairline, making it invisible.

          Procedure Type 3: This procedure is used when the bone in the frontal sinus area is too thin to shave down. The bone is removed, reshaped, and then replaced. 

          Forehead feminization surgery aims to create a smooth, balanced appearance by reducing the size of the brow bossing, frontal sinus, and orbital rims and making the forehead slope slightly forward. The specific procedure used will depend on the individual's biology. Surgery is performed through incisions made behind the hairline to minimize the visibility of scarring. The goal is to perform the least invasive procedure possible.

Male	Female

Picture 1. Shows differentiation between male and female foreheads

A Good Candidate for Forehead Contouring: 

          1. You have a typically masculine protruding frontal sinus bone, which can be contoured to create a more balanced facial shape.

          2. You are healthy and have realistic expectations about the procedure's outcome.

          3. You understand the risks associated with the procedure, such as potential scarring, infection, and nerve damage.

          4. You have consulted with a qualified plastic surgeon and have discussed the procedure in detail.

          5. You have a clear understanding of the recovery process and the potential side effects.

          6. You clearly understand the cost of the procedure and any potential financing options.

Preparation for the forehead contouring:

         Preparing for forehead contouring can be daunting, but it's important to ensure the best possible outcome. To ensure a successful procedure, it's important to: 

         1. Consult a highly skilled and experienced plastic surgeon to discuss your surgical goals, medical conditions, and current treatments.

         2. Undergo a health status and psychological examination, including blood tests, chest X-rays, electrolyte levels, and HIV tests.

         3. A CT scan is also necessary.

         4. Stop smoking and drinking alcohol for at least one week before surgery.

         5. Avoid taking aspirin, anti-inflammatory drugs, and herbal supplements, as they can increase bleeding and bruising.

         6. Stop eating and drinking at least 6 hours before surgery. 

Procedures for forehead contouring:

          The surgery is performed under general anesthesia and typically takes 2-3 hours to complete.

 Forehead contouring Type II.

         This procedure suits patients with thick bone over the frontal sinus but more feminine forehead features above the eye area. The surgeon grinds down the wall of the bone as much as possible without breaking through the frontal sinus to give a smooth and curved appearance. The bone can be reduced by approximately 2-3 mm by a high-speed electric burr. The scar is hidden as the incision is on the scalp behind the hairline.

         Type II foreheads have protruding anterior walls of the frontal sinus but standard frontal nasal angles. Sometimes, forehead shaving alone may achieve the perfect appearance, and you may need implants or bone cement to smooth out the whole area to a feminine shape.

Picture 2. A Detailed View of Frontal Bone Anatomy Males

Picture 3. illustrates the presence of a substantial bony overgrowth above the frontal sinus, suitable for reduction through shaving (Forehead Type II).

Picture 4. illustrates the thin bone over the frontal sinus, which is ideal for forehead contouring of type III.

Forehead contouring type III 

         It is a surgical procedure that involves reshaping the frontal bone of the forehead by removing a section of the frontal sinus.

         The removed bone is then reshaped and repositioned before being secured with silk stitches to the bone.

         The surrounding bones may also be contoured, and the orbital rims may be reduced to increase the dimensions of the anterior orbital rim. This procedure is typically performed to address cases of a prominent forehead bone and deep-set eyes. 

Post-operative Recovery:

         You will be given medical ice packs to apply to your face, most likely around the eyes, to control pain, redness, and swelling. 

         1. Avoid strenuous activity for three to four weeks.

         2. Apply ice compresses to your forehead for 20 minutes at a time throughout the first few days of recovery to reduce swelling and discomfort

         3. Keep the head elevated for 1-2 weeks after surgery to reduce post-op swelling

         4. Have a selection of button-up shirts ready to wear during recovery to prevent irritating the scalp.

         5. We will provide you with a compression garment, which you should wear as much as possible for at least two weeks to reduce swelling. 

Risks and Complications for Forehead Contouring:

         Complications for forehead contouring are generally rare, but as with any major surgery, there is a risk of bleeding, infection, and adverse reaction to anesthesia. Other potential complications include:

         1. Suture rupture along an incision line

         2. Visible scarring

         3. Fluid accumulation (seroma) beneath the skin

         4. Hematoma (bleeding)

         5. Injury to the facial nerve

         6. Exceptional cases may require additional surgery to correct facial asymmetry and enhance results

Recovery:

         Recovery: After surgery, you can expect to return to work within two weeks. However, avoiding heavy exercise for at least six weeks is important to allow proper healing.

         Although you'll be close to the final results three months after surgery, minor changes and improvements may still occur for up to 12 months. Forehead surgery is often considered one of the most critical procedures for facial feminization and can have a significant positive impact on the quality of life for transgender women.

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