Forehead and Brow Ridge Bone Contouring

OVERVIEW

Forehead and brow ridge bone contouring, also regarded as brow bossing reduction, is one of the most common facial feminization surgical (FFS) 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 and brow ridge bone contouring procedure will transform all male gender indicators on the forehead and upper eye areas to be completely feminine without doubt.

WHY FOREHEAD AND BROW RIDGE BONE CONTOURING?

In the context of anatomical terms, there are differences between male and female foreheads that you are required to understand as below:

Typically, male foreheads tend to have a prominent ridge running across the forehead above the eyes (brow bone bossing), giving a heavy masculine look of the upper face, whilst female foreheads tend to be smoother and flatter with little or no bossing. In forehead feminization, there are 3 areas of masculine bony prominences, which need to be taken into 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 the frontal sinus. The masculine shape of forehead bone can vary from the indented area over the bossing to the obviously notable area as a part of brow ridge bone.

In biological females, the shape of the 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 WIH craniofacial surgeons always pay attention to contour this part.

METHODS OF FOREHEAD AND BROW RIDGE BONE CONTOURING

WIH surgical techniques for forehead and brow ridge bone contouring can be classified as C-1, C-2 and C-3 methods of surgical interventions. To achieve the best feminization result, the most appropriate surgical method will be selected based on the patients' individual bone anatomy. 

C-1 method (Brow bone bossing shaving) 

The C-1 method is ideal for 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 the 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 the frontal sinus, the C-1 method involves only simple bone shaving (burring) without any reconstruction.

C-2 method (Brow bone bossing shaving with frontal sinus setback)

The C-2 method is suitable for 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 anterior wall sinus setback in the area of frontal sinus cavity.

Since the setback area of the 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 (Brow bone bossing shaving with frontal sinus reposition)

The C-3 method is the forehead reconstruction technique applied to the new contoured anterior wall of the frontal sinus. The C-3 method is suitable for patients who have the moderate to large size of frontal sinus (around 80 % of forehead contouring cases).

In this group of patients, the anterior wall of the 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 a feminine forehead. 

The newly contoured forehead will be secured with the micro titanium sheet and screws which are biocompatible, hypoallergenic and long-lasting and then meticulously covered by synthetic bone substance (calcium hydroxyapatite) to join with the surrounding bone to ensure the perfect integrity and beautiful shape of the new forehead.

DETAILS OF FOREHEAD AND BROW RIDGE BONE CONTOURING

Type of Anesthesia:  General anesthesia recommended for patient’s safety.

Operation Time:        2 hours

Length of Stay:         2 days 1 night 

FOREHEAD AND BROW RIDGE BONE CONTOURING AFTERCARE

  1. Following surgery, a soft dressing is placed around the forehead and left in position overnight.
  2. After the night of surgery, wear the compression garment as much as possible for at least 2 weeks to reduce swelling.
  3. In the first 72 hours after surgery, use a cold compress and sleep with your head elevated in a recliner or with 2 pillows to help reduce swelling and bruising.
  4. Avoid heavy lifting, vigorous exercise or strenuous activity for 4 weeks. The patient is encouraged to take gentle walks to promote healing.
  5. Wear button-up shirts during recovery to prevent irritating the scalp.
  6. Pain is well managed with prescribed medications.
  7. Stitches will be removed after 1-2 weeks, depending on your healing.

FAQs

1.    What is facial feminization surgery (FFS)?

Facial Feminization is a collection of different procedures that primarily aims to eliminate a person’s masculine facial features to become that of a woman’s visage.

The process of selecting the most suitable facial feminization procedures is very crucial and highly individualized which means a set of feminizing procedures is not suitable for all.

At WIH, our craniofacial surgeons hold a wide array of knowledge on facial feminization with expertise that has been molded through the years, to professionally work with one’s existing facial features and redesign them to achieve the best feminine versions.