Forehead recontouring

Brow bone reduction

The forehead is one of the more apparent gender markers. Brow bone reduction (also known as forehead recontouring or forehead contouring) is very powerful and can transform a prominent male forehead to fall within the average female ranges. Brow bone reduction is one of the core MtF FFS procedures of facial feminization surgery.

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Go to the before and after gallery

Difference between the 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.

Brow bone of male (left) vs female (right) skull.

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.

Notice the flat spot on the male forehead (left) compared to the female forehead (right).

3. Slope of the forehead

Because of the brow ridge, the general angle of the forehead in males is steeper 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 the nose and forehead is more open.

Because of the male frontal bossing the angle between the nose and forehead in men (left) is sharper than this angle in women (right).

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Feminizing the forehead

Brow bone reduction 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.

Burring away the lateral brow ridge with a brow bone reduction

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 the plate of bone in front of the frontal sinus, reshaping it, and placing it back in position with small titanium screws to hold the bone in place while it heals.

Drawing of skull showing frontal sinus as a limit for brow bone reduction

The central part of the brow ridge can often not be shaved down during a brow bone reduction because of the frontal sinus which lays behind it.

Brow bone reduction type 3 saw

The central part of the brow bone has to be remodelled with a saw because of the frontal sinus beneath.

Although the brow bone reduction process as described above is the most used, there are 4 types of brow bone reduction to be distinguished. Which one the surgeon uses depends on the prominence of your brow bone, the thickness of your frontal sinus wall and the size of your frontal sinus and forehead in general.

Type 1 brow bone reduction: 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 “feminization of the forehead”. Only a small percentage of patients will have a good result with this technique: those with only a small bossing or a small sinus (10%).

Brow bone reduction - Thick frontal bone

GOOD INDICATION for a type 1: 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 during a brow bone reduction.

Before and after brow bone reduction type 1 (good indication)

Despite what some surgeons might tell you, it is generally not possible to bring a male forehead into normal female ranges (indicated by the red line) with burring only because of the frontal sinus.

Brow bone reduction - thin frontal bone

BAD INDICATION for a type 1 brow bone reduction: Despite what some surgeons might tell you, it is mostly not possible to bring a male forehead into normal female ranges (indicated with the red line) by just shaving because of the frontal sinus.

Type 2 brow bone reduction: Shaving and Filling

This option has a limited indication and is overused by surgeons that don’t perform type 3 forehead reconstructions. It can be used properly when the projection angle between the nose and the forehead is already satisfying. Only the concavity after the bossing has to be addressed in that case. The concave area above the bossing will be filled with bone cement.

If a type 3 brow bone reduction is used when not really indicated, a ‘heavy’ dolphin-like forehead will be created. As you can see, although the new forehead is smooth, it bulges forwards of the “ideal” female forehead line (the ideal line is indicated in red on the drawing below).

Brow bone reduction - forehead shave and fill

BAD INDICATION for a type 2 brow bone reduction: If a type 2 brow bone reduction is used when not really indicated, a ‘heavy’ dolphin-like forehead will be created. As you can see, although the new forehead is smooth, it bulges forwards of the “ideal” female forehead line (the ideal female line is indicated in red).

Brow bone reduction type 2 vs type 3

Comparison of the brow bone reduction type 2 and 3 if you have a heavy forehead.

Type 3 brow bone reduction: 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, remodelled and put back. Forehead reconstruction is the most complex technique but also the most powerful.

Brow bone reduction - thin frontal bone

INDICATION for a type 3 brow bone reduction: frontal sinus wall has to be removed, shaved and placed back.

Brow bone reduction - reconstructed forehead

Reconstructed forehead after a brow bone reduction type 3.

Rx of the forehead before (left) and after (right) brow bone reduction type 3.

Before and after brow bone reduction type 3

Before and after brow bone reduction type 3

Type 4 brow bone reduction: Forehead reconstruction and Filling

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

Picture of patient before and after a brow bone reduction with forehead type 4

Before and after brow bone reduction type 4

 

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Procedure brow bone reduction

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

  • The solid orbital rims on the outside are shaved.
  • In case of a type 3 brow bone reduction the central bone plate over the frontal sinuses is removed, thinned until the desired thickness is achieved and reshaped.
  • Finally, the refined bone plate is fixed in place with titanium micro screws. The heads of the screws are removed so they cannot be felt or seen through the skin.

    The plate of the frontal sinus is fixated with screws.

  • 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 brow bone reduction

  • 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 brow bone reduction

  • Changed feeling of the scalp—Because skin is detached from the bone during the forehead recontouring 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.

Want to get a personal quote?

You have 3 options to receive your personal quote from Dr Bart van de Ven:

1 – Pictures evaluation (50 euro)

Dr Bart van de Ven will make a personal analysis of your face and give his surgical opinion of which procedures you need to feminize your face. He will send you a quote for these procedures and a simulation of the FFS result based on the pictures you upload. The payment of the 50 euro is processed by Paypal (you don’t need a Paypal account to pay with Paypal). You can upload the requested pictures as instructed in the form.

Request your quote and simulation based on pictures only

2 – Pictures evaluation + Skype consultation (100 euro)

The Skype consultation combines the pictures evaluation with a Skype consultation.

  • After booking your Skype consultations you will receive an email with instructions to send your pictures.
  • Before the actual Skype consultation, Dr Bart van de Ven will make a personal analysis of your face and give his surgical opinion of which procedures you need to feminize your face. He will send you a quote for these procedures and a simulation of the FFS result based on the pictures you upload.
  • During the consultation, Dr Bart van de Ven will answer all of your questions and explain the procedures suggested.
  • The available hours are the same as the Antwerp consultation below (every Monday and Wednesday afternoon, and Friday morning, Brussels time).

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3 – Live consultation (50 or 100 euro depending on the location)

Book a live consultation with Dr Bart van de Ven in Antwerp or one of the other cities he will be visiting. During your appointment, you will be able to address Dr Bart van de Ven with all of the questions you may have and he will give you his professional opinion on the procedures you might want or need. This is what you can expect from your FFS consultation. He will also make professional pictures and send a simulation of the FFS result based on the pictures after the consultation.

  • Antwerp, 50 euro, Belgium (every week):
    • every Monday and Wednesday afternoon, and Friday morning
  • London, 100 euro (every 3 months): Upcoming dates: 
    • Saturday September 21, 2019
    • Sunday September 22, 2019
  • Munich, 50 euro (every 2 months): Upcoming dates: 
    • Saturday October 5, 2019
    • Sunday October 6, 2019
  • Berlin, 50 euro (every 2 months): Upcoming dates: 
    • Saturday October 19, 2019
    • Sunday October 20, 2019
  • Vienna, 50 euro (every year): Upcoming dates:
    • Saturday November 16, 2019
  • Stockholm, 50 euro (every year): Upcoming dates:
    • Saturday May 30, 2020




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Worldwide consultations: 55.924586, 10.195313

All quote- and consultation fees are fully donated to the charity organisation of Dr Bart van de Ven.

Just want a general idea of costs?

Example of the cost of Jessica’s FFS

 

 

FAQ brow bone reduction

FAQs before brow bone reduction

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.

When can I have sauna again after my FFS?

You will have to wait for 4 weeks, then you are free to have a sauna!

What does this procedure cost?

There are 3 options to receive a financial and operative proposal. You can either send us pictures and receive a quote and an FFS simulation, or you can book a Skype or a live consultation with Dr Bart van de Ven during which you will also receive a quote and FFS simulation.

How do I get my FFS price request?

Click here if you want to get a general idea of FFS prices.

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.

Can I get this surgery if I’m a cis woman?

Yes, of course. We perform Facial Feminization Surgery on all women. Every woman is welcome at our clinic!

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.

Can I get this surgery if I’m a cis woman?

Yes, of course. We perform Facial Feminization Surgery on all women. Every woman is welcome at our clinic!

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 brow bone reduction

Is it safe to perform an MRI after FFS?

Yes, we use very small titanium screws and plates which are never a problem for an MRI. Also the bonecement does not contain metal.

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.

When can I start dying my hair again?

Before you can start stain your hair again after a forehead recontouring the incision should have healed 100%. If the incision was made a few cm inside the hair (no hairline lowering) this will take about 6 weeks. In case you had a hairline lowering this might take longer (up to 4 months).

I had a hairline lowering. I experience hair loss just behind the incision line. What is the cause and will it grow back?

The hair loss just behind the hairline is caused by reduced blood supply. The reduced blood supply is caused by the incision itself which cuts off the blood supply from the front and by the tension caused by the hairline lowering. The hair loss is at its maximum after about 1 month. Sprouting of blood vessels across the scar will create a new blood supply from the front and as tissues relax the tension will go down. This will ultimately result in a regrowth of the hair. To what extent and how long it will take varies per patient but in general most of the lost hair will be back after 6 months. If you want to do something about it you could use some Monoxidil lotion.

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.








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