Forehead recontouring

Forehead recontouring

Foreheads are one of the more apparent gender markers. Forehead reconstruction is very powerful and can transform a prominent male forehead to fall within the average female ranges.

FAQs about this procedure

Difference between male and female forehead

The 3 most important differences between male and female foreheads are:

1. Brow bossing

The main difference between male and female foreheads is that males often have a ridge of bone around the upper edge of the eye sockets called the “brow ridge” or “brow bossing”. Female foreheads tend to have little or no bossing.

2. Flat spot

Between the ridges of the two eye sockets a flat spot can be visible. As women don’t have the ridges, also the flat spot between them is not present.

Male skull notice frontal bossing and flat spot

Female skull, notice the smoothness

3. Slope of the forehead

Because of the brow ridge the general angle of the forehead in males is more steep and the angle between the forehead and nose is sharper in lateral view. Women, because they don’t have the brow ridge, have a more vertical appearance of the forehead in lateral view. The angle between nose and forehead is more open.

Male skull notice backslope of the forehead and sharp nose angle

Female skull notice the vertical forehead and open nose angle

Feminizing the forehead

Forehead recontouring is a procedure that involves brow shaving and surgically altering the bone.
The outer segments of the bossing that the eyebrows sit on are solid bone and can simply be filed down.

The section of bossing between the eyebrows sits over an area called the frontal sinus. Because the frontal sinus is hollow, it is more difficult to remove bossing there. It involves removing this plate of bone, reshaping it, and placing it back in position with small titanium screws to hold the bone in place while it heals.

The frontal sinus and her impact on forehead recontouring

 

Burring away the lateral brow ridge

Option 1: Shaving

Some patients have a very small sinus with a thick frontal sinus wall. In this case the excess amount of bone can just be burred away. This is what Dr Ousterhout calls a ‘type 1 forehead’. A lot of surgeons today can do only this: they burr away that small amount of bone and call it “feminisation of the forehead”. Only a small percentage of patients will have a reasonable result with this technique: those with only a small bossing or a small sinus (10%).

Despite what some surgeons might tell you, and despite there being some exceptions, we would say that it is generally not possible to bring a male forehead into normal female ranges without a forehead reconstruction.

Option 2: Shaving and Filling

This option has a limited indication and is overused by surgeons that don’t perform forehead reconstructions. It can be used when the projection angle between the nose and the forehead is already satisfying (type II according to Ousterhout). Only the concavity after the bossing has to be addressed in that case. The concave area above the bossing will be filled with bonecement (methylmethaccrylate). If used when not really indicated, a ‘heavy’ forehead will be created.

Option 3: Forehead reconstruction

The forehead recontouring procedure we perform the most (is most indicated) is the procedure that is called ‘type III’ procedure by Dr Ousterhout. During this procedure the anterior wall of the frontal sinus bone is removed, remodeled an put back. Forehead reconstruction is the most complex technique but also the most powerful.

frontal bossing reduction

frontal bossing reduction

Option 4: Forehead reconstruction and Filling

Sometimes it is necessary to use a combination of forehead reconstruction and some filling with methylmethaccrylate to get to desired forehead slope. Dr Bart van de Ven uses the bonecement more and more to get exactly the result he wants.

foreheadtypefour_beforeforehead before

 

Procedure

  • General anesthesia is given.
  • An incision is made along the hairline. The incision is made just like in scalp advancement surgery.
  • The forehead skin is pulled forward to reveal the bone.

  • The boneplate over the frontal sinuses is removed, thinned until the desired thickness is achieved and reshaped.
  • Then the solid orbital rims are shaved.
  • Finally the refined boneplate is fixed in place with titanium microscrews. The heads of the screws are removed so they cannot be felt or seen through the skin.
  • As in scalp advancement, the skin is fixed to the bone using Endotines to prevent it from pulling back.

    forehead recontouring ffs procedure scalp advancement forehead recontouring ffs procedure scalp advancement

Recovery

  • Hospital— You will spend one night in the hospital following surgery.
  • Pain—Pain may occur for a few days, which is controllable with normal painkillers.
  • Work—Many patients can go back to work within two weeks following this surgery (as stand-alone procedure).
  • Sport—Avoid physical activity that causes sweating or a rise blood pressure for eight days.
  • Sutures— Sutures are self-dissolvable. They dissolve in about a week time.
  • Forehead Numbness— Expect your forehead to be numb for about 3 months.
  • Blurred Vision (seldom, 5%)— Because of swelling around the eyes, some patients have noticed some degree of blurriness for 1 to 4 months.

Complications

  • Changed feeling of the scalp—Because skin is detached from the bone during the operation it is possible the feeling in the scalp changes. In most of the patients feeling returns to normal within the year, but some patients report the feeling doesn’t return 100% to normal. Most don’t feel this a problem though, just something they noticed.

FAQ

FAQs before surgery

Sometimes I get asked to model during a photoshoot. How long should I wait to book one after my FFS?

That is a very difficult one. It depends very much upon your healing and we can’t give you any guarantee about how long it takes before you look good enough for a photoshoot.
It could be 4 months, but it could also be a year. Of course it also depends on the amount of work that has been done.

What does this procedure cost?

If you want you can send us good pictures together with your ideas so we can send you a financial and operative proposal. To receive a proposal, please fill in the proposal request online and pay the proposal fee of 50 euro through Paypal.

Of course you are always welcome for a consultation.

For the forehead recontouring, is there any shaving required?

No, shaving is never required for the incision.

Is it safe for titanium screws staying inside my body for long term?

Yes it is. Two of the greatest benefits of titanium are its high strength-to-weight ratio and its corrosion resistance. Couple this with its non-toxic state and its ability to fight all corrosion from bodily fluids and it’s no wonder titanium has become the metal of choice within the field of medicine. Titanium is also incredibly durable and long-lasting. In principal they are not removed anymore and stay in the body. Only in case of an infection on the plates (rare) they will have to be removed.

Another benefit to titanium for use in medicine is its non-ferromagnetic property, which allows patients with titanium implants to be safely examined with MRIs and NMRIs.

How long does it take for the final result to be visible and the blue stains to disappear completely?

After the forehead recontouring procedure patients heal relatively quickly. However, healing is different for every patient. Mostly for this procedure a final result can already be visible after one to two weeks. But if the blue stains are severe (10% of patients, and there is no way to predict to whom this will happen), it can take up to 4 weeks for the blue stains to completely disappear.

Does bone grow back once it has been cut or shaved down?

In our experience no bone has ever grown back.

Is there a risk for sinus problems after forehead recontouring type 3?

Until now we have never had a patient complaining about sinus problems after this procedure.

 

Is the skull less strong after this procedure?

Weakening of the skull is not applicable; the skull is very strong and remains  strong.

Will I experience loss of nerve sensitivity in the scalp area?

For sure there will be temporary numbness of the scalp which recovers to a variable degree. I can be that the sensation of the scalp will never be as before, but nobody really makes a big deal of this.

What will the hairline scar be like?

The hairline scar will be irregularly curved for a natural effect. In the beginning it will be red and quite visible, but after about 6 weeks it will become less conspicuous and the hair will start to grow through the fine scar. Maturation of the scar will take approximately one year.

Will the scar be visible? That defends on the density of the hair just behind the hairline. If the hair is dense the scar will be hardly visible once the hair roots that have been pushed under the scar have grown through the scar. In case the hair is thin it could be the scar becomes visible when you pull the hair backwards.

FAQs after surgery

I feel air under my forehead skin after the operation, is this normal?

After a forehead recontouring there is often a connection between the frontal sinus and the space under the forehead skin. If you blow your nose, air can be pushed into that space. If you push the skin with your fingers you can hear a typical crackling sound. This is absolutely harmless.

This air escape will disappear in time when the skin is reattached to the bone. To help this process you will be provided with a forehead mask, which you should wear for two weeks. This mask will push the skin against the bone. Also care should be taken not to blow your nose too hard. After two weeks you can take the mask off and carefully try to blow your nose. If still air escapes to the space under the skin, the forehead mask must be used longer.

Will type 1 forehead recontouring give me the best possible results?

In about 1 out of 3 patients that need forehead recontouring Dr van de Ven will use only shaving (type 1). In all other patients he does the type 3 forehead recontouring meaning the anterior wall of the frontal sinus needs to be set back. If Dr van de Ven proposes a type 1 forehead recontouring he does this because he really thinks he can have the best possible result with it and can save the patient some costs (type one is cheaper because it’s less work). If during the surgery he will come to the conclusion it would be better for the patient to perform a type 3 recontouring he will without charging extra costs.

I’m having double vision in the first week after forehead recontouring, is this normal?

It is possible the first two weeks because of the swelling around the eyes double vision occurs (5 procent of patients). This is annoying and evening frightening but ALWAYS resolves. We never had a patient with permanent double vision.

How long does it take for the final result to be visible and the blue stains to disappear completely?

After the forehead recontouring procedure patients heal relatively quickly. However, healing is different for every patient. Mostly for this procedure a final result can already be visible after one to two weeks. But if the blue stains are severe (10% of patients, and there is no way to predict to whom this will happen), it can take up to 4 weeks for the blue stains to completely disappear.

When can I start using Minoxidil on my hair after forehead reduction or hairline lowering?

You can start Minoxidil after proper healing of the incision wounds, three to four weeks after surgery.

After a hairline lowering and browlift I now have bumps along my hairline which are irritating, do these settle down?

Those bumps are the Endotines that have been placed just inside the hair to prevent the hairline from pulling back. They will resorb in about a year, sometimes even a bit more.

How long does it take for the endotines to disappear?

According to the manufacturer it takes about 3-6 months for the endotines to absorb. According to our experience it takes about 6-18 months before the endotines dissolve completely.

When can I wash my hair?

Almost immediately. Don’t be alarmed if the wound bleeds a little bit while washing your hair. For wound healing it’s very good to remove all excessive blood cloths and crusts, even better when you use shampoo. Just remember to blow-dry thoroughly and dab with a drying antiseptic, like alchohol, afterwards to eliminate any remaining moisture.

You still have another question? Feel free to ask! We will answer your question and if generally applicable add it to the FAQ of this page.