FTM Mastectomy WIH International Hospital

Feminizing Forehead & Brow bone surgery

Male to Female Forehead contouring surgery & Forehead reconstruction surgery

Forehead/ brow ridge bone contouring is one of the most common facial feminization procedures which can be performed as a stand-alone procedure or combined with other FFS procedures if needed. For the purpose of facial feminization, the forehead/ brow ridge bone contouring procedure will change all male gender indicators on your forehead and upper eye areas to be completely feminine without a doubt. To achieve the best feminization result, Dr. Chettawut carefully selects the most appropriate surgical method based on the patients’ individual bone anatomy. There are 3 areas of masculine bony prominences which need to be taken in consideration as follows:

1. Brow ridge or Brow bossing: This is the horizontal ridge of bone across the lowermost part of the forehead. It is actually the upper orbital ridge (superior orbital rim) which tends to protrude around eyebrow level and sometimes shows a “deep set orbit” appearance.

2. Forehead bone: This implies mainly the lower forehead located right above the brow bossing. It is the anterior wall of frontal sinus. The masculine shape of forehead bone can vary from the indented area over the bossing to obviously notable area as a part of brow ridge bone. In biological female, the shape of forehead is vertically rounded and the contour is usually smooth without stepping.

3. Lateral orbital rim: This implies the side of orbit where the extension of the cheek bone joins with the upper orbital ridge. This part can also be very prominent in males and Dr.Chettawut always pays attention to contour this part.

Dr.Chettawut’s surgical techniques for forehead and brow ridge bone contouring can be classified as C-1, C-2 and C-3 based on the method(s) of his surgical interventions.

The details are as following:

C- 1 method

Dr. Chettawut’s C-1 method is suitable for the patients who have no sinus cavity (absence of frontal sinus) or have a very small frontal sinus. In this group of patients (around 10 % of forehead contouring cases), the outer surface of frontal bone and/or anterior wall of sinus is uniform and thick enough to shave down into the desired contour. Since there is no setback or reposition of the anterior wall of frontal sinus, C-1 method involves only simple bone shaving (burring) without any reconstruction.

C- 2 method

Dr. Chettawut’s C-2 method is suitable for the patients who have a small frontal sinus. In this group of patients (around 10 % of forehead contouring cases), the anterior wall of frontal sinus is thin and not enough to shave down into the desired contour without sinus cavity involvement. The surgical interventions involve both bone shaving in the area beyond the sinus cavity and also anterior wall sinus setback in the area of frontal sinus cavity. Since the setback area of anterior wall is quite small, the reconstructed method requires only synthetic bone substitute (calcium hydroxyapatite) to cover the small bone defect. There is no titanium sheet applied to the reconstructed area.

C- 3 method

C- 3 method is Dr. Chettawut’s forehead reconstruction technique applied to the new contoured anterior wall of frontal sinus. The C-3 method is suitable for the patients who have moderate to large size of frontal sinus (around 80 % of forehead contouring cases). In this group of patients, the anterior wall of frontal sinus is always thin and the frontal sinus setback into a more posterior position is mandatory in order to achieve the best possible outcome of feminine forehead. The C-3 method requires 4 steps of surgical intervention as following:

1. Setback the anterior wall of frontal sinus and preserve the sinus membrane for being a “barrier” between the setback area and sinus cavity. This delicate process requires extensive cranio-facial surgical skills to protect the posterior wall of frontal sinus which is close to cranial cavity.

2.Bone shaving along the periphery of frontal sinus. The bone shaving will be done meticulously to smoothen the edge of setback area to the surrounding bone.

3.The use of micro titanium sheet for reinforcement of the new contoured forehead and titanium screws for rigid fixation. The titanium sheet and screws are absolutely biocompatible and safe (do not induce an allergic reaction) and lasts for life.

4.The use of synthetic bone substance (calcium hydroxyapatite) to cover the entire defect and joined with the surrounding bone to ensure the perfect integrity and beautiful shape of new forehead.

Example skull x-ray in variation of frontal sinus anatomy