FFS forehead

FFS
FOREHEAD FEMINIZATION
FAQ

Facial Feminization - Forehead Reconstruction

The shape and volumes of the forehead and orbital area (frontonasoorbital complex) are often key signals of gender.

The brow ridge is the frame of the eyes and can determine whether an individual has a masculine or feminine appearance.

What is Facial Feminization Surgery of the Forehead?

Forehead feminization involves the reconstruction of the forehead area, sometimes in conjunction with the hairline or the nose. This aims to give the patient a softer look and more feminine expression.

Why is FT a pioneer in Facial Gender Affirming Surgery for the forehead?

Facialteam has been trusted by thousands of patients for facial feminization surgery of the forehead for many reasons. Our 13 years of experience and high satisfaction rate inspire confidence in prospective patients.

We are always working to pioneer new techniques and advancing the scientific basis to make sure we can offer our patients the very best in facial gender surgery, with natural looking results and quicker recovery times.

Gender differences of the forehead

Male skulls tend to have a more prominent forehead and brow bone (the ridge over the eyes and the nose) as well as greater volume in the lateral eye areas (orbits).

A female forehead is typically rounded, with a smooth transition between the nose and forehead, and almost never has prominent brow bones. That is the look that we aim to achieve with our forehead reconstruction.

Objectives of Forehead Feminization

The main aim of our forehead feminization procedures at Facialteam is to achieve a very significant change in the expressiveness of the patient.

This means approximating the contours of the skull before the effects of puberty caused them to develop differently.

Thanks to our experience with more than 1400 patients we have been able to develop an innovative approach, minimising scarring and with safe techniques that allow for a more seamless recovery.

How is a Forehead Feminization performed?

 

Forehead and brow reconstruction is a procedure that may involve the shaping of the entire area and the surgical reconstruction of the anterior wall of the frontal sinus.

The brow area is located just over the frontal sinus, which is a hollow air cavity in most people. Despite its appearance, the brow bone over this cavity is normally very thin (2 mm thick)., So, a significant bulge can’t be removed by just surface shaving.

There are two main problems with over-shaving just over the sinus cavity: potential perforation of the plate and the difficulty of achieving a smooth transition between nose and forehead if only using this approach.

An excision of the bone plate (osteotomy) is the best way to profoundly remodel the forehead properly and remove excess bone volume.

Subsequent shaving and solid and fixation in a new ideal position (with titanium micro-screws) will correctly which stabilize the bone segment during healing. This method offers a safe and predictable forehead feminization resultNote: micro-screws are not visible through the skin.

The technique has the capacity to give the forehead a more oval shape and reduces the marked frontonasal ridge (brow angle between the nose and forehead).

As the soft tissue is also lifted, patients also enjoy. A forehead appear more youthful appearance withand more femininegives the eyebrows placement a more feminine look.

This is all done through a hidden incision in the scalp, so  scar  largely unnoticeable within be totally invisible under the hair.

Post-op and Results: What to expect after a Forehead Feminization

 

After a forehead reshaping procedure, which may well be combined with other procedures, you should be up and about within a few days . FT requires a minimum 1-2 night hospital stay. Bruising and swelling, if present, will fadediminish within a few weeks., Patients should wait 8 weeks before participating in any high impact physical activity.

You will likely notice results almost immediately after surgery. But it’s important to know that things will continue to improve over the course of the following months.

The type of incision in the scalp and the suturing technique we use will allow hair growth through the scar only a few months after surgery. This will take time to fill in completely.

All patients may request for a final checkup after 1 year, when things will have settled for the most part and the evolution may be accurately assessed.

Paired FFS procedures

At Facialteam, we believe in a holistic approach to surgery, so often combine procedures, using the same incisions for different facial features. This not only helps to minimise scarring but also is an exercise in efficiency which may save patients multiple trips for operations.

In the case of FFS forehead surgery, it’s often paired with hairline feminization. That’s because there’s an incision made in the scalp (invisible after surgery). Due to repositioning, an excess strip is discarded when only forehead reconstruction takes place. However, when combined with simultaneous hair transplants (SHT), the hairs of this strip is taken advantage of. Follicular units are obtained for grafting immediately afterwards in the desired areas of the hairline, to give it a more rounded appearance.

Forehead reconstruction surgery may also be paired with a feminising rhinoplasty. As the transition between the forehead and the nose is a key aspect of the face, addressing this section of the face as a whole can be vital in achieving a feminine look.

Forehead feminisation and aesthetic procedures

Depending on the patient, we may recommend that alongside a forehead reconstruction and rhinoplasty, a blepharoplasty is performed.

The skin around the eyes is often where ageing is most visible, which is why eyelid surgery can be very beneficial for a brighter, more youthful appearance.

It removes bags, pouches and excess skin from under and over the eyes. If there is excess eyelid tissue, it can easily be combined with forehead feminization.

How is the forehead region accessed?

When accessing the forehead region (forehead, nasal root, orbits and supraorbital ridge) for reconstruction purposes, a modified coronal approach is one of the approaches most often used by Facialteam. The modified coronal approach was developed by Drs. Capitán and Simon. 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.

Forehead Feminization Procedure

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 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 frontonasoorbital 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 frontonasoorbital 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.

BIBLIOGRAPHY

If you are interested in learning more about the Forehead Reconstruction technique, please read our scientific article titled:

Facial Feminization Surgery: The Forehead. Surgical Techniques and Analysis of Results

Luis Capitán, Daniel Simón, Kai Kaye and Thiago Tenório
Plastic and Reconstructive Surgery
October 2014