Forehead Contouring / Forehead Shaving
Figure 1: Forehead Contouring
There are 3 categories for forehead contouring:
Type I Forehead : Forehead contouring procedure that involves implant at the mid forehead area to improve the curve of forehead profile. There are options for implant materials: Injectable material, fat graft or permanent implants.
Type II Forehead: Forehead contouring procedure that involves bone shaving above the eye area or brow bossing, and the frontal sinus area by using contouring bur. The bone can be reduced by approximately 3-5 mm. The incision is on the scalp behind the hairline.
Type III Forehead: Forehead contouring procedure that involves anterior walls of the frontal sinus, can be performed to set back and reshape the forehead. This procedure is preserved for those who have prominent forehead bone and deep-set eyes. This procedure surgeon obtain pre-operative computed tomography (CT) scans to confirm the forehead types.
To enhance the femininity and reduce masculinity of the facial features, forehead shaving or forehead contouring type III and brow bone shaving are the most important procedures for the upper part of your face. There are many differences between men’s and women’s foreheads. First is brow bossing, or a ridge of bone at the eyebrow level consisting of a frontal sinus which is in the middle and orbital rims above the eyes. Male foreheads are often sloped slightly backwards, also known as Samurai forehead. The expression of the masculine forehead can make one look harsh or “angry” constantly. In this procedure, the surgeon shaves the frontal sinus and orbital eye rims to reduce and adjust the forehead bone for a smooth and balanced appearance.
|Male forehead||Female forehead|
Picture 1. Differentiation between male and female foreheads
Why consider forehead contouring?
It is extremely difficult to hide facial features you are not comfortable with, as opposed to less-than-perfect body features. Especially for transgender people whose gender identity is different from that assigned to them at birth, the possibility of altering facial features can be key to their transition. Being seen as female can also help transgender women avoid harassment and discrimination. However, as with any surgery, good physical and mental health will be a necessary precondition.
Risks and complications
Like any major surgery, there may still be risk of bleeding, infection, damage to the forehead bone structures, facial asymmetry and adverse reaction to anesthesia. Other complications may include:
- Suture rupture along an incision line
- Visible scarring
- Fluid accumulation beneath the skin (seroma)
- Solid swelling of clotted blood within your tissues (hematoma)
- Dissatisfaction with appearance after surgery
- Facial nerve injury
Sometimes additional surgery is needed to correct facial asymmetry and improve the final outcomes.
How to prepare for the surgery
- Consult with your surgeon
- Physical and psychological examination, including blood test, chest X-ray, electrolytes level, HIV, liver function, kidney function
- CT scan is required
- Stop smoking and drinking alcohol at for least one week before surgery
- Stop some medicines, vitamin or herbs that interfere with blood clotting such as aspirin
The surgery is performed under general anesthesia, taking 2-3 hours to complete.
Suitable candidates and surgery procedures
Forehead contouring Type II
This procedure is suitable for patients who have normal sinuses and normal desirable female forehead protrusion with both standard bossing and concavity above the eye area. The surgeon grinds down the wall of the bone as much as possible without breaking through frontal sinus to give a smooth and curved appearance. The bone can be reduced approximately 2-3 mm by an electric high-speed burr. The incision is on the scalp behind the hairline.
Type II foreheads have protruding anterior walls of the fron-tal sinus, but normal frontal nasal angles. To improve the contour, augmentations of the area above the protrusion can be done with implants or bone cement
Picture 2. Thick bone over frontal sinus, that is available for shaving (Forehead Type II)
Picture 3. Thin bone over frontal sinus suitable for forehead contouring type III
Forehead contouring type III
This procedure is performed by removing and reshaping the frontal wall of the sinus. Then the area around the frontal sinus bone is grounded down, and reshape the forehead with titanium microplate and screw. Sometimes wires may be used instead of screws and plate. The surrounding bone can also contoured. The orbital rim can be bured down to increase the dimensions of the anterior orbital rim. The procedure is preserved for those who have prominent forehead bone and deep-set eyes
After forehead shaving and brow bossing, pain, redness and swelling in your face, most noticeably in your eyes can be expected. Stitches are removed 10 days after surgery. You will need to sleep face-up, with your head elevated, for at least 1-2 weeks after surgery to help control post-op swelling. Avoid over exercise for one month. You can begin moderate exercise within three to six weeks.
Definitive and stable results might not be completely visible until up to a year after surgery. During your recovery period, you will continue to talk to specialists who are involved in your treatment about the evolution of your facial features and any complications you experience. All in all, forehead surgeries can dramatically improve the quality of life in transgender women.