Forehead Feminization Surgery – The Forecontour® Technique
What is forehead feminization?
Forehead feminization is a surgery focused on modifying the upper third of the face to soften typically masculine features, such as a prominent forehead bone, marked supraorbital ridges, and the shape of the hairline. It is one of the most impactful procedures in the facial feminization process, as the forehead and eyes play a central role in gender perception.
Visually, the difference between a masculine and feminine forehead can be compared to the contrast between a hill and a plain. Masculine foreheads tend to have sharper angles and prominent bone structures, while feminine foreheads exhibit a smoother and more continuous curve from the hairline to the eyebrows. This difference directly affects how facial expressions are perceived: a prominent forehead may convey a more severe or intense look, whereas a softened forehead is often associated with delicacy and harmony.
Capturing these subtleties can make a major difference in how people feel about their image. This surgery not only reshapes bone structure, but helps align facial appearance with gender identity.
What is a Type 3 forehead?
Type 3 foreheads are characterized by a prominent frontal bone bossing that partially or completely covers the frontal sinus. This is the most common pattern among trans women assigned male at birth. It typically requires a combination of osteotomy to reposition the frontal bone wall, burring of adjacent areas, anatomical reconstruction, and reshaping of the supraorbital ridge. In some cases, a brow lift may also be indicated to achieve harmony in the upper third of the face.
Forehead feminization is a transformative procedure, reshaping the entire forehead region. To truly understand this process, watch our detailed 3D Video showcasing each step of the procedure.
What does the Forehead Feminization Forecontour® procedure include?
Forecontour® is an exclusive surgical technique developed by Facialteam that stands out for its comprehensive and highly personalized approach. The process begins with an advanced diagnostic phase, including 3D CT scans to evaluate the bony anatomy of the upper face in detail.
Based on these data, a detailed digital plan is created. Specific software is used to design bone cuts to be performed during surgery. Custom surgical guides, 3D printed for each patient, ensure accurate execution according to the preoperative plan.
Surgery is performed through a posterior coronal incision, offering full visibility of the area to be treated while preserving hairline aesthetics. Two main techniques are combined: burring, to soften the prominent frontal bone, and osteotomy with reconstruction, where the anterior wall of the frontal sinus is removed, reshaped, and replaced to achieve a more feminine contour.
The procedure also addresses the lateral transition toward the temples and the brow ridge, with the possibility of a brow lift when indicated. The goal is not only to modify bone structures, but also to preserve function and achieve natural results.
Forecontour® is more than a surgical technique—it is a complete system of evaluation, planning, and execution developed by Facialteam over more than a decade, aiming to provide highly accurate, safe, and identity-aligned upper facial feminization for every patient.
Am I a good Candidate for Forehead Feminization Surgery?
This procedure is especially indicated for individuals with Type 3 foreheads or marked bony features. It is suitable for those seeking a natural, long-lasting change with no visible scarring, and who wish to harmonize their facial expression with their gender identity. It is also recommended for patients interested in combining forehead surgery with other procedures like facelifts or hair transplantation.
Preoperative assessment and technology
FOREContour® merges cutting-edge technology with surgical expertise to ensure maximum precision in planning and execution. Key technological highlights include:
We use high-resolution 3D photography with the VECTRA® H1 system to capture multi-positional facial scans. These images allow detailed facial analysis and guide an effective feminization diagnosis.
3D CT scans produce full reconstructions of the frontonaso-orbital complex, enabling a deep understanding of bony contours and allowing the surgical plan to be tailored to the patient’s anatomy.
Custom 3D-printed surgical guides are designed based on these scans, translating the virtual plan into precise intraoperative execution, enhancing both safety and predictability.
During surgery, ultrasonic surgical instruments like the piezoelectric scalpel are used for clean bone cuts without damaging soft tissues. This reduces trauma and shortens recovery.
Our methodology, developed over 14 years and supported by more than 2,200 successful procedures, has been featured in leading scientific publications.In patients with receding or M-shaped hairlines, the strip of scalp tissue obtained from the coronal incision can be used to perform a simultaneous hair transplant using the SHT technique, optimizing capillary feminization.
Detailed procedures and techniques
Preoperative planning phase
Surgical planning begins with a 3D CT scan of the skull. A digital model is generated to design precise bone cuts. Custom surgical guides are then produced via 3D printing and used during the procedure to ensure accuracy. The sequence is as follows:
- Initial Assessment and Imaging: A 3D CT scan is conducted, offering a comprehensive visualization of the facial structure.
- Surgical Planning: Using specialized software, we evaluate the facial structure to determine the personalized reconstruction needed for each area.
- Frontal Sinus Analysis: We closely examine and measure the frontal sinus, an air-filled cavity in the middle of the forehead.
- Creation of Surgical Guide: Based on the data collected, an anatomically precise 3D surgical guide is generated. This guide, instrumental in making accurate bone cuts around the frontal sinus area, is then 3D printed in preparation for surgery.
Initial surgical steps
Under general anesthesia, a posterior coronal incision is made several centimeters behind the hairline. Soft tissues are carefully lifted to expose the forehead and orbital rims, providing excellent visibility without affecting the natural hairline.
Incision and Scalp Removal: The surgery begins by selecting the optimal incision area, considering the patient’s hair density and quality to ensure a future scar remains hidden. A strip of scalp is then carefully removed.
Access to Forehead and Orbital Region: This approach grants complete access to the forehead and orbital region, crucial for the subsequent steps.
Placement of the Surgical Guide: The previously 3D-printed anatomically accurate surgical guide is fixed in position, setting the stage for precision bone work.
Bone Cut with Ultrasonic Technology: Using advanced ultrasonic technology, a bone cut is made along the guide, enhancing the safety and predictability of the procedure.
Removal of Anterior Wall of Frontal Sinus: The anterior wall of the frontal sinus is delicately removed, allowing it to be sculpted separately, ensuring its functionality and integrity remain intact.
Contouring and reconstruction
Burring softens the frontal bone, and for Type 3 cases, osteotomy is performed to remove, reshape, and reattach the anterior wall of the frontal sinus. The supraorbital ridges and temple transitions are also contoured to create a smoother, more feminine profile.
Contouring Gender Markers: Specific gender-associated markers on the forehead are meticulously contoured to achieve a more feminine appearance.
Repositioning the Sinus Wall: The sinus wall is then carefully repositioned and secured with microscrews, preserving the functionality and integrity of the sinus structure.
Reinforcement with Titanium Mesh: In cases where there are gaps or weak areas, a specially adapted titanium mesh may be placed for additional support and stability.
Gaining Expressiveness and Brow Positioning: As a result of these anatomical alterations, patients experience enhanced expressiveness, and the eyebrows naturally settle into a higher position, contributing to a more feminine facial profile.
Optional hair transplant phase
While not always necessary, a hair transplant may be performed later to refine the hairline, fill M-shaped recessions, or increase density. This is customized based on each patient’s goals and coordinated with the hair restoration team.
Addressing the Removed Scalp: Revisiting the strip of scalp removed at the surgery’s outset becomes crucial for hairline feminization.
Follicular Unit Extraction: A team of specialized technicians carefully extract the individual follicular units from the removed strip of scalp.
Preparing Grafting Sites: The recipient sites on the hairline are then prepared, ensuring they’re ready to receive the follicles.
Follicle Placement: These follicles are strategically placed to create a natural, dense, and either a more feminine or rounded hairline, depending on the patient’s goals.
End Result: This meticulous approach to hair transplant ensures a harmonious hairline that aligns well with the newly contoured forehead, providing patients with both functional and aesthetic benefits.
Resulting Changes
The anatomical adjustments lead to enhanced facial expressiveness, with eyebrows settling in a naturally elevated position.
Combined surgical technique: burring + reconstruction
In the Forecontour® approach, burring and reconstruction are complementary. Burring sculpts the bone when thickness allows, while osteotomy is required for more severe bossing. Reconstruction ensures safety and restores the sinus wall’s protective function.
By combining both, surgeons can address a wide range of cases—from moderate to complex—with optimal control, adapting the technique to the degree of masculinization and desired aesthetic outcome.
Posterior coronal approach – A pioneering technique developed by Facialteam
“There is no previous description of this type of approach in medical literature. It is an exclusive access method developed by Facialteam to maximize surgical field visibility without compromising hair aesthetics.” — Dr. Luis Capitán, co-founder of Facialteam.
Facialteam has developed and patented a unique surgical access method: the posterior coronal approach. This technique offers significant advantages, including a completely hidden scar behind the hairline, broader surgical visibility, reduced wound tension, and the possibility of harvesting hair follicles for grafting.
While this is our preferred and most advanced method, it is important to understand the other common surgical approaches to forehead feminization: the anterior coronal approach and the hairline (pretrichial) incision.
Anterior coronal approach
This technique involves an incision across the top of the head, closer to the hairline. While it offers relatively good surgical access, it can place more tension on the incision site and may be visible depending on the patient’s hairstyle or hair density. It also may not be suitable for patients planning hair transplants due to limited donor area preservation.
Hairline incision
This approach places the incision along the natural hairline, intending to advance or redefine it. While it may seem advantageous in terms of immediate aesthetic correction of the hairline, it can leave visible scarring, especially in patients with thin or receding hair. In some cases, it also limits the surgeon’s ability to fully access and contour the frontal bone and orbital region.
Why do we prefer the posterior coronal approach
After over a decade of clinical application and refinement, the posterior coronal technique remains our gold standard due to its combination of excellent exposure, optimal healing, and aesthetic advantages. However, at Facialteam, we recognize that each patient’s needs are unique. Our team evaluates every case individually to determine the most suitable approach and always informs patients about the benefits and drawbacks of each option during the surgical planning phase. and patented a unique surgical access method: the posterior coronal approach. Currently, it is the only team in the world offering this technique, which provides both aesthetic and functional advantages.
Benefits include a completely hidden scar, improved surgical access, potential donor site for hair grafts, and reduced incision tension. Common misconceptions are clarified: the technique does not increase forehead height, the scar is invisible even with short hair, and it avoids drawbacks associated with hairline incisions, such as visible scarring or changes in hair pattern.
Phases of the surgical process
The process includes several steps: an initial consultation with 3D CT, digital surgical planning, and 3D guide production. Surgery lasts 2–3 hours under general anesthesia, followed by one night in the hospital. A 10–14 day stay in Spain is recommended for postoperative care. Follow-up can be done in person or online.
Cost of the procedure
Choosing forehead feminization surgery involves evaluating not just the price but also the value each center offers. Facialteam’s pricing reflects a highly specialized, multidisciplinary process focused on safety, natural results, and long-term well-being.
The cost of Type 3 forehead feminization surgery with Facialteam (including hospital and anesthesia) typically ranges between €19,900 and €21,300, although final pricing may vary depending on case complexity and optional components.
Quotes cover all essential services: pre-op consultation and preparation, CT scans, operating room and anesthesia, hospitalization, postoperative accommodation (approx. 12 nights in Spain), lymphatic drainage massage, acupuncture, nursing care, 24-hour coordination support, and a 30-day surgical complications insurance. We recommend comparing quotes from different centers, as inclusions vary significantly.
Complementary Facial Soft Tissue Procedures
Blepharoplasty
The most frequent candidates for eyelid surgery or upper blepharoplasty are usually those who, because of their features, have an apparent excess of skin in the area.
It is important to detect those patients who have drooping or low eyebrows, since in these cases blepharoplasty alone does not sufficiently clear the eyelid and it may be necessary to add an eyebrow lift to achieve a noticeable result on the look.
Blepharoplasty is a highly recommended procedure to be combined with our FOREContour® procedure.
Surgical safety and possible complications
When performed by an experienced team, forehead feminization is a safe procedure. At Facialteam, with over 3,000 surgeries performed, our complication rate is under 1%.
Possible complications include prolonged swelling, rare infections, abnormal scarring, or temporary changes in sensation. In rare cases, revision surgery may be needed. Our protocols ensure close follow-up, advanced prevention, and 30-day medical coverage for any complications.
Postoperative recovery
Recovery progresses steadily and is supported by clinical and logistical care provided by Facialteam.
First week: most patients stay one night in the hospital. For the next 3–5 days, moderate swelling and discomfort are normal. Patients in Spain stay near the clinic for daily check-ups. Lymphatic drainage massages begin during this phase to reduce inflammation.
Second week: many return to light activities. Swelling begins to subside, and patients can walk and resume basic routines. Stitches are removed if needed, and the recommended stay (10–14 days) is completed.
First month: strenuous activity is discouraged, though social and light work activities can resume. Numbness may persist but improves gradually.
3 to 6 months: final results become more defined as swelling resolves. Skin texture and sensation normalize progressively, with most outcomes fully visible by the sixth month.
Digital planning, advanced surgical techniques, and close follow-up ensure a safe, informed, and supported recovery journey.
Natural results and emotional well-being
Beyond the physical transformation, upper facial feminization has a profound emotional impact. Many patients report significant improvements in self-esteem, gender congruence, and overall quality of life.
Why choose Facialteam?
Facialteam is a global leader in facial feminization. With a patented technique, a multidisciplinary team, and a scientific, ethical approach, over 3,000 surgeries have been performed with natural results and comprehensive care. Every patient receives personalized follow-up and ongoing support.
Book your Consultation
Request your evaluation with our surgical team. We will guide you through your diagnosis, surgical options, and next steps.
We offer both online as in-person consultations in our clinic in Marbella, Spain.
Our consultations are free of costs and a great aid for those patients seeking advice to start their journey.
Research & Education in Forehead Feminization Surgery
Facialteam’s R&D group has established a new framework of modern protocols in FFS of the forehead. For us, advancements in science translate into offering our patients the very best in facial gender surgery, with natural looking results and quicker recovery times.
The development of FOREContour® is the culmination of years of research and clinical practice. The traditional technique (described in 2010) has been innovated with new technologies for greater customization to the anatomy of each individual.
Publications
This technique is based on several scientific articles produced by our group throughout our clinical practice. Our academic literature is a record of our dedication to the science of feminization surgery of the upper facial third since 2008.
Facial Feminization Surgery: The Forehead. Surgical Techniques and Analysis of Results
Facial Feminization Surgery: Simultaneous Hair Transplant during Forehead Reconstruction
The Upper Third in Facial Gender Confirmation Surgery: Forehead and Hairline
