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Forehead recontouring: the process, the types, the results

When choosing to feminize your features, a forehead recontouring or brow bone reduction can help to eliminate masculine characteristics above the brow. Discover the possibilities and the four different techniques below.

What makes a forehead masculine?

Masculine

• A (protruding) brow ridge or brow bossing
• A flat spot between the brow ridges
• A slanted, more angled forehead

Feminine

• Little to no brow bossing
• No flat spot
• A vertical, rounder forehead

A male human skull (left) vs. a female human skull (right)

Feminizing the forehead

A brow bone reduction is a procedure that involves brow shaving and surgically altering the bone:

• Solid bone such as brow ridges or brow bossing can simply be shaven away.
• The section of bossing between the eyebrows sits over an area called the frontal sinus. Because the frontal sinus is hollow, it is more difficult to shave bossing there. It involves removing the plate of bone in front of the frontal sinus, reshaping it, and placing it back into position with small titanium screws to hold the bone in place while it heals. Alternatively, the sinus can be filled with bone cement (preferred by Dr Bart van de Ven).

The central part of the brow ridge can often not be shaved down during a brow bone reduction because of the frontal sinus which lays behind it. Simple shaving of the bone over the frontal sinus would create a cavity.

How your brow bone and forehead can be altered depends on:

• the prominence of your brow bone;
• the thickness of your frontal sinus wall;
• the size of your frontal sinus and forehead in general.

Four types of brow bone reduction

According to the American FFS pioneer Dr. Douglas K. Ousterhout, four types of brow bone reduction or forehead recontouring can be performed to create the desired results.

Type 1 brow bone reduction — Shaving

• Suitable for people with a very small or absent sinus with a thick frontal sinus wall. Only 10% of our patients have this type of forehead.
• In this case, the excess amount of bone can just be burred or shaven away.
• Possible complications: if the bone is so thin at the end of the procedure that after weeks/months, a hole still forms in the frontal sinus front wall. If the bone has too little blood circulation it can disappear. If the hole is small and doesn’t create a visible dimple this is no problem though.

Brow bone reduction - type 1 - shaving

Type 2 brow bone reduction — Shaving and Filling

• This type is sometimes used when the projection angle between the nose and the forehead is already satisfying. Only the concavity behind the bossing has to be addressed in that case.
• It involves minimal shaving and the concave area above the bossing will be filled with bone cement (see yellow and orange on the sketch).
• Possible complications: although the new forehead is smooth, it can look like a ‘heavy’ dolphin-like forehead that bulges slightly when compared to the ‘ideal’ female forehead line (see red line on the sketch). Therefore, it is not our favored type of procedure.

Type 3 brow bone reduction — Forehead reconstruction

• This type is mostly favored because most patients have a medium to large sinus.
• During this procedure, the anterior wall of the frontal sinus bone is removed, remodeled and put back with titanium screws. Alternatively, the sinus can be filled up with bone cement. The surrounding bones are also contoured if needed and possible.
• Possible complications: changes to the shape of the frontal sinus could feminize the resonance (amplification of vocal sounds). (Semi-)professional singers that wish to keep their masculine resonance should be aware of this risk and weigh the pros and cons.

Brow bone reduction - type 3 - forehead reconstruction (before surgery)

Brow bone reduction - type 3 - forehead reconstruction (after surgery)

Type 4 brow bone reduction — Forehead reconstruction and Filling

• When a patient has a slanted or angled forehead, a type 3 procedure might not be enough. Additional filling using bone cement can be used to get the desired forehead slope.
• Possible complications: The same complications can occur as for the previously mentioned procedures.

Brow bone reduction - type 4 - forehead reconstruction and filling (before and after)

How is the procedure performed and what can you expect?

Discover the entire process on our website and don’t forget to ask Dr. van de Ven for extra details if something isn’t clear. He’ll be happy to explain the procedure and what you can expect.

Read all the surgical steps and what to expect

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