Feminizing the Forehead (Reduction and Contouring)

What is Forehead Feminization? (AKA Forehead Contouring, Forehead Reduction, Brow Ridge Recontouring)

The forehead is one of the most important facial features for gender identification. There are notable differences between men and women–in a hairline pattern, the eyebrow shape, the size of the eyes, and the shape of the forehead.

Perhaps no other facial feature distinguishes your gender than the forehead.

Men tend to have a visible horizontal ridge of bone just above eyebrow level called the brow ridge or glabellar bossing. In comparison, women tend to have foreheads with a rounded, smoother, more even surface.

The aim of Forehead Feminization via Contouring and Reduction within the context of Facial Feminization is to create a more feminine, softer appearance of the forehead, and reduce the heavy appearance of the male brow.

How does Forehead Contouring and Reduction work to enhance Facial Feminization (FFS)?

Forehead Contouring is one of the most important surgical procedures included in Facial Feminization Surgery (FFS) because the forehead encompasses almost 30-40% of the entire face surface, and essentially frames all other facial features.

Contouring along with Hairline Lowering or Scalp Advancement significantly changes the look of a male forehead to be more female in appearance and contribute to a more naturally feminine-looking forehead.

Contouring also shapes the forehead and the bones around the eye sockets, which serves to minimize the noticeably heavier bony ridge of a masculine-looking forehead. Contouring opens up the appearance of the eyes, which helps to transform and feminize the forehead.

Forehead prominence can be increased or decreased as aesthetically desired, and depressions may be filled in when appropriate; however, this is not our approach in the majority of cases. Also, any congenital facial asymmetries are improved by forehead contouring.

Dr. Ousterhout, Dr. Deschamps-Braly’s associate, pioneered the first forehead feminization in 1982. Dr. Ousterhout also developed the classification system that we rely upon for all types of forehead contouring. There are essentially four types of procedures that were developed in order to properly feminize the forehead contours:

  1. Type I forehead has a minimal or absent frontal sinus, and adjustments to the shape may need to be made with burring.
  2. Type II forehead has a protruding anterior wall of the frontal sinus but the projection is normal for a female. Therefore, we will augment the area above the protrusion in this type of correction.
  3. Type III forehead has a protruding anterior wall of the frontal sinus that is projected foreward in excess of normal for the desired shape. In this case an osteotomy is performed of the anterior table of the frontal sinus and we then setback and reshape the forehead.
  4. Type IV forehead is small in general and under projected. In this type, we will augment the entire forehead.

All of the above aesthetic aspects need to be taken into consideration, along with your unique facial features – the features that are uniquely “you” – during forehead feminization.

How is Forehead Contouring surgery performed within FFS?

During your FFS surgical consultation, Dr. Deschamps-Braly will plan for the correct contour and desired shape of your forehead. Planning is done based on science, artistry, extensive feminization experience, and aesthetic intuition. He will catalog a battery of measurements during your consultation which allows him to plan for the most appropriate approach to your surgery.

Dr. Deschamps-Braly utilizes custom-made precision instruments to reshape the hairline, forehead bones, brows, and eye regions to ensure a more feminine appearance.

The procedure begins with an incision either right at, or just behind, the hairline – depending on whether or not the hairline position needs to be repositioned.

The exact procedure varies from patient to patient, but most often the brow bone is osteotomized and reconstructed to reduce the size of the forehead, and the orbital bones are shaped to modify masculine characteristics.

The frontal bone (between the eyebrows) is removed, shaped, and then reattached so that it does not interfere with the underlying sinus cavity.

Forehead contouring is often done in conjunction with a brow lift or hairline restoration because of the location where the incisions are made.

Which is better stainless steel or titanium?

We prefer to use non-magnetic stainless steel wire for reattaching the forehead bone. In part, because this type of wire does not create unwanted delays at airport security, or issues during an MRI if one is needed in the future.

While we have had great experiences with titanium plates and screws overall, and our cosmetic surgery practice has used them since the 1980’s (when the first commercially available titanium plates and screws were introduced) we do not find them appropriate for forehead surgery.

Also, it is only very recently have titanium plates become sufficiently thin so as not to be felt under the skin post-surgery and years later. This consideration is important because as we age, we lose estrogen which causes the skin to thin over time. Additionally, plates of this thinness do not have the strength we require to rebuild the forehead.

If the forehead needs reshaping, or a ridge or concavity needs filling, the doctor will use a biologically inert synthetic material to create a more rounded feminine shape.