Forehead feminization is a transformative operation that dramatically changes the appearance of the upper third of the face. Forehead feminization reduces, contours, and reshapes the forehead bone. It is a type of Reduction Cranioplasty. The forehead is one of the most important facial regions for gender identification. The shape and size of the forehead, eyes, eyebrows, and hairline are quite different in masculine and feminine features. All of these features can be altered using the hairline, skull, brow bone, and eye area reshaping that Dr. Costa offers to produce the changes desired.
Dr. Costa uses techniques in reshaping and lowering the hairline, reducing and reshaping the forehead, brow bone, and eyes that produce a natural appearance with inconspicuous scars.
Who is a Candidate for a Reduction Cranioplasty?
A Forehead Reduction Cranioplasty is commonly performed for transgender patients. Cisgender men and women who would like to change and reduce the appearance of their forehead also benefit from these techniques.
Presenting Features of Masculine and Feminine Foreheads
Males tend to have a more prominent mid-forehead. Males also tend to have a prominent horizontal ridge of bone running across the forehead at or just above eyebrow level. This is known as the brow bone, or brow ridge. “Brow bossing” refers to a prominent brow bone and is considered a masculine facial feature. Female foreheads tend to be smoother, flatter and do not have brow bone bossing. The part of the brow bone that rests over each eye is known as the supraorbital rim. In males, the orbital rims tend to hang over the eye area making it appear more closed. In females, the orbital rims tend to be smaller, flatter, and do not descend into the eye area, resulting in the eye having a more open appearance. The area of the brow bone between the eyebrows, or glabella, sits in front of an air space with bone behind it. This air pocket is called the frontal sinus. Because this air space sits behind the bone, removing the bone alone rarely treats the brow bossing adequately.
Feminizing Forehead Cranioplasty
A Forehead Reduction Cranioplasty, Forehead Contouring, Browbone Reduction, or Forehead Setback creates a softer appearance to the forehead and eyes, resulting in a more feminine facial appearance.
Forehead and Orbital Contouring can be done to reduce the brow bone and smooth any irregularities of the forehead bone.
Orbital Rims
The supraorbital rims are reduced and reshaped during a brow reduction procedure. This reshapes the orbit, where the eyes sit. Removing and reshaping the bone gives the eye a more open, feminine appearance. Dr. Costa carefully reduces and reshapes these areas, creating a natural, softer appearance. A prominent brow bone can give the appearance of deeper set eyes. Prominent ridges over the eyes are a more masculine feature. Smoothing the forehead and contouring the rims around the eyes provide a more feminine appearance with softer features.
Forehead Setback
Most patients are best treated with a Type 3 Forehead Reduction Cranioplasty. Dr. Melinda Costa uses CT scan imaging as part of the preoperative assessment and planning to determine which procedure you will need.
Cutting Edge Surgical Planning
Dr. Costa utilizes Three Dimensional Imaging to virtually plan the reconstruction, which is individualized and customized to each patient. Custom cutting guides and 3D models are used to provide remarkable results.
Types of Forehead Reduction Cranioplasty
A Type 3 Forehead Feminization Reduction Cranioplasty for Forehead Feminization provides the maximal amount of setback to the forehead. The bone overlying the frontal sinus is removed by first making an opening into the bone, or craniotomy. The bone overlying the frontal sinus is then removed by completing the osteotomy. This bone segment is then contoured and placed in a more recessed position. The bone segment is stabilized and delicate bone graft is placed around the entire perimeter of where the bone segment has been inset. With these techniques, the frontal sinus bone heals with a natural contour. Dr. Costa, who also trained extensively in Pediatric as well as Adult Craniofacial Surgery, uses resorbable plates and screws, which are used extensively in children as well as adults. These plates and screws hold the bone segment securely and have the benefit of dissolving over time. Titanium plates can be used as well.
A Type I Forehead Feminization Reduction Cranioplasty is when the bone of the forehead is burred, or shaved down. A Type 1 setback is a less powerful procedure than a Type 3 and is generally not sufficient to produce the desired result. It is only appropriate about 5% of the time. This is because the amount of setback is limited by the thickness of the frontal bone. If the bone is very thick, and/or a small forehead reduction is desired, this procedure may be appropriate.
Type 3 versus a Type 1 Cranioplasty
A Type 3 Reduction Cranioplasty is nearly always the procedure of choice because it is more versatile and able to produce a large amount of setback. A sufficient reduction may not be achieved with a Type I Reduction Cranioplasty. Furthermore, if a Type 1, or burring, procedure is performed and the bone is not sufficiently thick, holes may be made in the bone and this compromises the final result. Enough of a setback would not be achieved and there can be problems that arise if there is a hole left in the bone segment sitting in front of the air filled bone, or frontal sinus. Care must be taken to leave sufficient bone to preserve the integrity of the frontal bone segment at all times.
Hairline Lowering, if desired, is done at the same time. A Brow Lift is done at the same time as the Feminizing Forehead Reduction Cranioplasty as well.