The forehead is one of the more apparent gender markers.  Forehead contouring (also known as forehead recontouring, brow bone reduction or forehead reshaping surgery) is very powerful and can transform a prominent male forehead to fall within the average female ranges. Forehead Contouring is one of the core Facial Feminization Surgery procedures.

Forehead Contouring is often undertaken in conjunction with a brow lift or hairline lowering because of the location of the surgery and to ensure a harmonious and aesthetically-pleasing result.

On average, the cost of Forehead Contouring (brow bone reduction) in Iran is between $1500_$2000. This price includes all the related medical expenses including anesthesia, doctor’s visit, surgery, and follow-up fees.

Before Forehead Contouring Surgery

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.

2. Flat spot

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

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.

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How does forehead contouring enhance your appearance?

The forehead makes up almost 35-40% of the entire facial surface. It dominates and aesthetically affects all other facial features so if it is out of balance in some way it will affect your whole facial shape. For example, you may feel that your forehead and brow area are too broad or too prominent creating an ‘overhanging’ effect over the eyes. Your forehead may also be asymmetrical in shape, or appear too masculine or too feminine for your specific gender expression, or out of balance with your other facial features in some way.

For Trans and cisgender women, forehead contouring improves the facial profile by creating a more feminine and harmonious interplay of how the forehead aesthetically relates to other facial features. The procedure shapes the forehead–and also the delicate bones around the eye socket–to minimize the bony ridge of an overly-prominent forehead. Reduction and reshaping of the brow also work to “open up” the eyes, helping to transform and feminize the upper facial area.

For Trans and cisgender men, the challenge may be that the forehead is not masculine enough in appearance. In such cases, depending on your existing facial features and the desired result, we may instead recommend forehead lengthening and augmentation.

Are you an ideal candidate for forehead contouring?

You are an ideal candidate for forehead contouring if you are a relatively healthy adult who feels that your forehead and brow is in some way detracting from your appearance.

Our most common forehead contouring patients are Trans women as a part of their facial feminization surgery or cisgender women who feel that their brow and forehead is too prominent or ‘masculine-looking.’ However, we may also perform forehead reshaping and contouring on Trans or cisgender men who feel that their forehead is too ‘feminine’ or oddly-shaped in some way.

Forehead contouring can usually be done to fulfill the following:

. Reducing the forehead protrusion

. Improving the curve of the forehead profile

. Correcting a forehead bone depression

Complications

. Changed feeling of the scalp—because the skin is detached from the bone during the forehead contouring it is possible the feeling in the scalp changes. In most of the patients, sensation returns to normal within the year, but some patients report the feeling doesn’t return to normal 100%. Most don’t report this as a problem, but rather something they noticed.

. Infection

. Asymmetry

. Non-satisfying aesthetic result

. Double vision in certain directions (temporary frequent, permanently rare)

. Reduced sensation of the forehead skin (temporary always, permanently rare)

. Changes to the shape of the frontal sinus could change the resonance (amplification of vocal sounds). (Semi-) professional singers should be aware of this risk and weigh the pros and cons.

. Temporary spasm of the frontal muscle which creates a ’surprised look’

During Forehead Contouring Surgery

Feminizing the forehead

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

Different types of Forehead Contouring (brow bone reduction)

Although the Forehead Contouring (brow bone reduction) process as described above is the most used, there are 5 types of Forehead Contouring (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 Forehead Contouring (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 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%).

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

. Type 2 Forehead Contouring (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 behind the bossing has to be addressed in that case. The concave area above the bossing will be filled with bone cement.

If a type 2 brow bone reduction is used when not really indicated, a ‘heavy’ dolphin-like forehead will be created. Although the new forehead is smooth, it bulges forwards when compared to the “ideal” female forehead line

. Type 3 Forehead Contouring (brow bone reduction) — Forehead reconstruction

The forehead recontouring procedure performing the most is called the ‘type III’ procedure. During this procedure, the anterior wall of the frontal sinus bone is removed, remodeled and put back. Sometimes it is necessary to use a combination of forehead reconstruction and some filling with bone cement to get the desired forehead shape. We use the bone cement more and more often to get the exact result he wants.

. Type 4 Forehead Contouring (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 the desired forehead slope. We use the bone cement more and more often to get the exact result he wants.

. Type 5 Forehead Contouring —Forehead augmentation

Once there’s a depression on the patient’s forehead or the forehead is extremely flat, contouring can be achieved through forehead augmentation or implantation.

In this type of surgery, different kinds of materials, like silicone sheet and Gore-Tex, are inserted/implanted on the frontal bone to contour the surface.

As an alternative to forehead augmentation, fat injection can be used to give the patient a natural-looking full forehead. However, this method does not render permanent results.

During Procedure

How is Forehead Contouring surgery performed?

. The surgery lasts around 2-3 hours. The method of performing the surgery varies based on the patient’s anatomy.

. General anesthesia is given.

. An incision is made along the hairline. The incision is made just like it would be made during scalp advancement surgery (forehead reduction).

. The forehead skin is pulled forward to reveal the bone.

. The solid orbital rims on the outside are shaved.

. During a type 3 Forehead Contouring (brow bone reduction), the central bone plate that covers 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.

. As with scalp advancement, the skin is fixed to the bone using Endotines to prevent it from pulling back.

After Forehead Contouring Surgery

Recovery

. Hospital— you will spend one night at the hospital following surgery.

. Pain—Pain may occur for a few days, and is manageable with normal painkillers.

. Work— many patients can go back to work within two weeks following this surgery (as a stand-alone procedure).

. Sport—Avoid physical activity that causes sweating or a rise in blood pressure for eight days.

. Sutures—Sutures are self-dissolving. They dissolve in about a week’s 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.

We take steps before surgery to ensure that your bruising and swelling is kept to a minimum. However, you may still have some swelling for at least a week or two. Also, it is common to have some minor swelling that may last up to two months.

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 depends 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.

How long does it take until the sutures in my hairline dissolve?

The white skin sutures dissolve in 1 or 2 weeks. If they would still be in the skin after 2 weeks they will easily break when you pull with your fingers.

Can I lose feeling (numbness) permanently in some areas following FFS surgery?

Some temporary numbness in any of the areas where bone work is done is an absolute certainty. That could include the scalp, forehead, chin, jaw or even cheek areas depending on where the surgery has been done. This happens because the soft tissue is detached from the bony area. Several thousand minor nerves are severed, and it will obviously take some while for those areas to heal. Up to 18 months of recovery time is not unusual, but it usually takes less time. You may not regain the same level of feeling as before.

Forehead Contouring Surgery Cost

The price of Forehead Contouring (Brow Bone Reduction) surgery will vary depending on your circumstances and the degree of change required for a satisfactory result. In fact, it is almost impossible to forecast the financial commitment that is needed until your surgical consultation.

However, when considering the price of your surgery, there are a few factors to take into consideration:

. Your existing features: the degree of forehead reduction, contouring, and/or reshaping you may require

. If any additional procedures are necessary, for example, a brow lift and/or hairline lowering.

. Any pre-existing health conditions that may affect your surgery

. Hospital-specific fees

On average, the cost of Forehead Contouring (brow bone reduction) in Iran is between $1000_$2300. This price includes all the related medical expenses including anesthesia, doctor’s visit, surgery, and follow-up fees.