FOREHEAD RE-CONTOURING & ORBITAL RESHAPING

The Forehead is one of the most revealing gender traits. The reconstruction of the forehead can significantly transform a prominent masculine forehead into a well-defined feminine brow.

Gender of the forehead region

Males tend to have a more prominent forehead and brow bone (frontal-orbital complex: the ridge over the eyes and the nose) as well as  in the lateral eye areas (orbits). A female forehead is typically rounded and almost never has prominent intra-orbital areas. In profile, female foreheads tend to be more vertical instead of inclined inwards.

Forehead feminization

The remodeling of the forehead and brow is a procedure that involves the sculpture of the entire area and a complex surgical reconstruction of the anterior wall of frontal sinus. The outer segments of the brow prominence which support the eyebrows are called “supraorbital ridges”. This is clearly prominent in males.

The brow area lays over the frontal sinus. Because the frontal sinus is a hollow air cavity, it is more difficult to eliminate the bulge only with surface shaving, not only because of potential surgical complications but also due to the inability to achieve an appropriate transition between the nose and forehead.

This sculpture in the frontal area creates a more oval format and eliminates the marked  frontonasal ridge (angle between the nose and forehead).  In addition, it determines a new position for the  soft tissue, so that we can achieve a lifting effect of the forehead skin and a replenishment of the eyebrows in a more feminine format. The overall effect is a very significant change in the look and the expressiveness of the patient. This procedure, thanks to our experience in hundreds of patients, has been innovated both in the approach (usually at the crown level), avoiding the undesirable hairline scar) as well as in the techniques and suturing.

In addition, we now offer the possibility of hair transplantation in the same week in front feminization surgery, a revolution both in results and in saving time and travel.  Patients now may obtain a maximum result in only 10 days, receiving both bone feminization of  entire upper third of the face and a new oval hairline, without the dreaded hairline scars.

Procedure

Thanks to our experience, we have developed a surgical approach that eliminates the dreaded scar in the hairline but still permits the repositioning of the eyebrows in a subtly elevated position as well as natural lifting effect of the forehead. The incision of the modified crown approach (Capitán & Simon) is completely hidden within the hair of the patient and is performed in a way that allows the subsequent growth of hair around it.
Once shaving of the orbitofrontal bone region is complete, we proceed to remove the anterior wall of frontal sinus (frontal osteotomy), sculpting it carefully to ensure that no undesireable perforation of the bone fragment occurs.  At this point, it is necessary to sculpt the whole  frontonasoorbitaria region, the sides and roof of the orbits, aiming for more open orbits that generate a more expressive, feminine and young look.
Finally, the bone plate is fixed in its new position with titanium micro-screws. The screw heads are removed, becoming invisible through the skin. By positioning the scalp in a new position use two resorbable fixation devices (Endotines ®) to help stabilize the eyebrows in their new location and format. Both the incision in the scalp and suturing technique will allow hair growth through the scar only a few months after surgery. In some patients, it is necessary to employ hair transplants to improve the hairline shape and entries(peaks).  This may be performed in the same week as FFS, which allows to achieve an optimum overall result in a short frame of time.

Post operative and possible complications of frontal reshaping

Hospital: It is recommended that patients remain hospitalized for 1 to 2 days after the surgical procedure.
Bandage: Immediately after surgery, we will place a compression bandage around the forehead, which will be removed one day after surgery.
Pain: The patient may experience pain for a few days but it is perfectly controlled with standard analgesics.
Work: Most patients can return to work between two and four weeks after surgery.
Sport: Patients should avoid physical activity that causes sweating or increases blood pressure during eight days after surgery.
Sutures: the sutures are removed between seven to nine days after surgery.
Infections are very rare, but the antibiotics are administered for protection. You can have swelling and edema on the preorbital area (around the eyes) that will disappear between ten to twelve days post surgery. Numbness may be experienced in the area of the forehead which can last from weeks to months.

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