The forehead and orbital areas are one of the most revealing gender traits, being the frame of the eyes which determines if the individual has a masculine or feminine appearance. The reconstruction of these areas can feminize the features, giving the patient a softer look and sweeter expression
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, with a smooth transition between nose and forehead, and almost never has prominent areas.
The remodeling of the forehead and brow is a procedure that involves the sculpture of the entire area and surgical reconstruction of the anterior wall of the frontal sinus. The outer segments of the brow prominence which support the eyebrows are called “supraorbital ridges”.
The brow area lays over the frontal sinus, which is a hollow air cavity. Despite its appearance, the brow area is normally very thin (2mm thick), meaning that a successful elimination of the bulge is not possible with just an aggressive surface shaving, due to two main problems: potential surgical complications from over-shaving and the inability to achieve an appropriate transition between the nose and forehead.
For proper remodeling and elimination of excess bone volume, it is more accurate to conduct an excision of the bone plate (osteotomy), subsequent shaving and careful replacement and fixation (in a receded location compared to its original position) with titanium micro-screws which stabilize the bone segment during healing.
This sculpture in the frontal area creates a more oval format and eliminates the marked frontonasal ridge (brow 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 more than 600 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 as forehead 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 the entire upper third of the face and a new oval hairline, without the dreaded hairline scars.
We regularly collaborate with Alexandra Hamer of Virtual FFS, and she has a very clear and informative overview of forehead FFS on her website
The Forehead Before & After Gallery
HOW IS THE FOREHEAD REGION ACCESSED?
When accessing the forehead or frontonasal-orbital area (forehead, nasal root, orbits and supraorbital ridge) for reconstruction purposes, one of these two approaches can be used:
A 2 or 3 mm incision is made behind the hairline, with the sides of the incision hidden in the scalp. This approach is the most suitable for patients undergoing hairline lowering surgery.
The modified coronal approach was developed by Drs. Capitán and Simon and is one of the approaches most often used by FACIALTEAM to access the forehead region. A hidden incision is made in the scalp which, among other advantages, makes the scar completely undetectable after the surgery. Furthermore, its special design makes it possible to obtain follicular units that can be used for hair transplantation immediately afterwards (during the same forehead reconstruction surgery), facilitates hair growth through the scar itself, prevents hematomas (bleeding after surgery) and allows for a lifting effect above the eyebrows. This is the best approach when the patient does not need hairline lowering surgery.
Thanks to our experience, we have developed a surgical approach that eliminates the unsightly scar in the hairline but still permits the repositioning of the eyebrows in a more feminine and elevated position as well as natural lifting effect of the forehead.
The incision of the modified coronal 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 the contouring of the orbitofrontal bone region is complete, we proceed to remove the anterior wall of the frontal sinus (frontal osteotomy), sculpting it carefully to ensure that no undesirable 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 youthful look.
Finally, the bone plate is fixed in its new position with titanium micro-screws. The screw heads are removed, becoming invisible and not palpable through the skin. By positioning the scalp in a new position , we use re-absorbable fixation devices (Endotines ®) to help stabilize the eyebrows in their new location and format. Both the type of incision in the scalp as well as the 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. If delayed, hair transplantation session can also be performed 4 to 6 months after the forehead surgery.