The forehead is one of the more apparent gender markers. Forehead reconstruction is very powerful and can transform a prominent male forehead to fall within the average female ranges.
Before forehead recontouring
After forehead recontouring
Before frontal bossing reductio
After frontal bossing reduction
Gender of the forehead
The male has more brow bossing (the ridge above the eyes) and a forehead that angles more steeply away from the eyes. The female forehead is typically rounder in all dimensions and almost never has a prominent brow bone. In profile, female foreheads are more vertical instead of backward sloping.
A side effect of browridge contouring combined with a browlift is a large surplus of forehead skin. Therefore the approach to the forehead is done through in incision just inside the hairline so the skin surplus can easily be excised.
Feminising the forehead
Forehead recontouring is a procedure that involves brow shaving and surgically altering the bone.
The outer segments of the bossing that the eyebrows sit on are called the “supraorbital rims”. These are solid bone and can simply be filed down.
The section of bossing between the eyebrows (the glabella) sits over a an area called the frontal sinus. Because the frontal sinus is hollow, it is more difficult to remove bossing there. It involves removing this plate of bone, reshaping it, and placing it back in position with small titanium screws to hold the bone in place while it heals.
The blue areas indicate where bone can be removed.
Notice the differences between the male and female skull. The forehead runs more vertical in women than men. The supraorbital rim is developed more in men than in women.
X-ray before frontal bossing reduction
X-ray after frontal bossing reduction
Procedure
General anesthesia is given.
An incision is made along the hairline. The incision is made just like in scalp advancement surgery.
The forehead skin is pulled forward to reveal the bone. The boneplate over the frontal sinuses is removed, thinned until the desired thickness is achieved and reshaped.
Then the solid orbital rims are shaved.
Finally the refined boneplate is fixed in place with titanium microscrews. The heads of the screws are removed so they cannot be felt or seen through the skin.
As in scalp advancement, the skin is fixed to the bone using Endotines to prevent it from pulling back.
The foreheadskin is fixed to the bone using small reabsorbable devices called Endotine (Coapt Systems Inc, Palo Alto), one on each side.
Recovery
Hospital: Most patients will spend one to two nights in the hospital following surgery.
Dressing: A dressing is placed around the forehead after surgery, and left in place during the first night. It can be removed the day after surgery.
Pain: Pain may occur for a few days, which is controllable with normal painkillers.
Work: Many patients can go back to work within two to four weeks following surgery.
Sport: Avoid physical activity that causes sweating or a rise blood pressure for eight days.
Sutures: Sutures are generally removed within nine days.
Complications
Infection: Infections are extremely rare, but antibiotics are used to avoid potential infections.
Swelling: Swelling and bruising may occur around the eyes, but will dissipate within ten to twelve days.
Numbness: Forehead numbness may last several months and often doesn’t recover completely.
