Facial feminization surgery / Forehead and brow bone
Forehead Contouring and Brow Bone Reduction
The brow bone is often the most defining area of the face. Forehead contouring reshapes it: the bone over the frontal sinus is set back, the rims of the eye sockets are contoured, and the brows can be lifted in the same operation. It is craniofacial surgery, and Dr. Steven Ovadia is fellowship-trained in it.
Overview
Why the forehead changes a face
A heavy brow ridge, a prominent bone over the eyes, and a forehead that slopes back are among the strongest skeletal cues of a masculine face. They set how the eyes sit, where the brows rest, and how light falls across the upper face. Because of that, the forehead is one of the areas that changes the most in facial feminization surgery.
Forehead contouring works on the bone itself. That is what separates it from a brow lift alone or from fillers: once the brow bone is reshaped, the eyes open up and the brows can sit where they belong, and the result is permanent.
What is done
The procedures, one by one
Frontal sinus setback
Reshaping the brow bone
The frontal sinus is the air-filled space behind the brow bone. In a frontal sinus setback, the bone over the sinus is removed, reshaped, and set back into a flatter position, then fixed in place. This is what removes the prominence of the brow and opens up the upper face.
Not every forehead needs the sinus set back. The right approach depends on how thick the bone is and how large the sinus is, which Dr. Ovadia assesses on a CT scan before surgery.
Orbital contouring
Opening up the eyes
The rims of the eye sockets are contoured, especially along the upper and outer edges. Softening and rounding these rims opens up the eyes and changes how the brow sits over them.
Brow lift
Repositioning the brows
The brows can be lifted in the same operation, through the same incision. A gently arched brow sitting above the orbital rim is one of the features that reads as feminine, and lifting the brows also tightens the forehead skin over the newly shaped bone.
Hairline lowering, when it fits
Through the hairline incision
When the forehead is reached through an incision along the hairline, the hairline can be brought forward and reshaped at the same time. Read more on the hairline lowering page.
Which of these are part of your surgical plan depends on your anatomy and your goals. Dr. Ovadia goes over each one with you at your consultation, with your CT scan in front of you.
Incisions
How the forehead is reached
Forehead and brow bone surgery is done through an incision at the top of the head. Where that incision sits is one of the first decisions in planning, because it determines where the scar is and whether the hairline can be changed.
Pretrichial incision
Along the hairline
Pretrichial means "in front of the hair." Across the front of the forehead, the incision runs along the hairline, right where the hair begins. At the temples it moves back behind the hairline, into the hair. Because the central part sits at the hairline itself, the hairline can be lowered or reshaped during the same operation.
- Along the hairline in front, behind the hairline at the temples
- Hairline can be lowered or reshaped
- Often chosen when the forehead is tall
Coronal incision
Behind the hairline
The incision runs across the top of the scalp, behind the hairline, where it is hidden within the hair. The hairline stays where it is.
- Scar is hidden within the hair
- Hairline position does not change
- Often chosen when the hairline is already in a good position
Which incision is right for you depends on the height and shape of your hairline and on your goals. When the hairline is to be lowered, the pretrichial incision is the one that allows it; read more on the hairline lowering page.
Recovery
What to expect afterward
Recovery from forehead contouring follows the same pattern as the rest of facial feminization surgery. The full guide is on the recovery page; these are the points that matter most for the forehead.
Swelling
Swelling is normal and expected. As a general guide, about half settles by 6 weeks and the rest by 6 months. Swelling around the eyes is often most noticeable in the first week or two.
Compression and sleeping position
A facial compression garment is an important part of recovery, and sleeping with the head of the bed elevated helps limit swelling, especially early on.
Numbness
Temporary numbness of the forehead and scalp is common. It comes from nerves being stretched during the operation, and it improves over time. Permanent numbness is very uncommon.
Sutures and staples
We typically use some sutures that come out after 5 to 7 days, and some staples in the scalp that come out after 7 to 14 days.
Normal swelling comes on slowly. A rapid increase in swelling is something to watch for, and it should be brought to your physician's attention right away. The complete recovery guide, with the timeline, is on the recovery after FFS page.
Your surgeon
Bone surgery is craniofacial surgery
Setting back the brow bone and contouring the eye sockets are operations on the facial skeleton. That is the work of a craniofacial surgeon, and Dr. Ovadia completed a fellowship in craniofacial and pediatric plastic surgery at UT Austin and Dell Children's Hospital. He also completed a fellowship in gender-affirming surgery at Johns Hopkins, so the planning is done with the whole face, and the whole patient, in mind.
He is board certified by the American Board of Plastic Surgery and sees patients in New York City and in Jersey City and Millburn, New Jersey. Read more about his approach on the facial feminization surgery page.
Questions
Common questions about forehead contouring
What is brow bone reduction?
Brow bone reduction is surgery that reshapes the bone of the forehead and brow so it sits flatter and smoother. In facial feminization surgery it usually means a frontal sinus setback, in which the bone over the frontal sinus is removed, reshaped, and set back, together with contouring of the rims of the eye sockets. The brows are often lifted in the same operation.
Why is the forehead such an important part of facial feminization surgery?
The brow bone is often the most defining area of the face. A prominent brow ridge, a heavy bone over the eyes, and a flat or sloping forehead are among the strongest skeletal cues of a masculine face. Changing the forehead changes how the eyes, brows, and upper face read as a whole, which is why it is the area that changes the most for many patients.
Do I need a CT scan before forehead surgery?
Yes. The thickness of the bone and the size and shape of the frontal sinus vary a great deal from person to person, and they determine how the forehead can be reshaped safely. Dr. Ovadia reviews a CT scan as part of planning your surgery.
Where is the scar?
Forehead and brow bone surgery is done through an incision at the top of the head. With a pretrichial incision the scar runs along the hairline in front and moves behind the hairline at the temples. With a coronal incision the scar is hidden in the hair behind the hairline. Dr. Ovadia recommends one based on your hairline and your goals.
Can the forehead be done on its own?
Yes. Facial feminization surgery is a group of procedures, and each surgical plan is built around the individual. Some patients have forehead surgery alone, some have it with rhinoplasty, and some choose to do the upper face first and the lower face at a later stage.
How long does swelling last after forehead contouring?
Swelling is normal and expected. As a general guide, about half of the swelling settles by 6 weeks and the rest by 6 months. Everyone is different, so treat this as a rough guide. Normal swelling comes on slowly. A rapid increase in swelling should be brought to your physician's attention right away.
Next step
Start with a consultation
Dr. Ovadia will examine your forehead and brow, review your CT scan, and explain which procedures and which incision make sense for you.
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