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.

Alexis full FFS before and after

Forehead recontouring natural man

Rita Forehead recontouring, hairline lowering and rhinoplasty (after 6 months)

Diana forehead recontouring and hairline

Lana’s facial feminisation surgery

Naomi forehead recontouring

Cindy facial feminization surgery before and after

Frontal bossing reduction

Bella facial feminisation surgery

Labhoise Facial Feminization Surgery before and after

Lea forehead recontouring

Elisa forehead recontouring and rhinoplasty

Gender of the forehead

The male has more brow bossing (the ridge above the eyes) and a forehead that steeply angles away from the eyes. The female forehead is typically rounder in all dimensions and almost never has a prominent brow bone. In profile, female foreheads are more vertical instead of backward sloping.
A side effect of browridge contouring combined with a browlift is a large surplus of forehead skin. That is why the approach to the forehead is done through in incision just inside the hairline so the skin surplus can easily be excised.

Man skull

Prominent brow bone.
Forehead that angles more steeply away from the eyes.

Female skull

No prominent brow bone.
More vertical forehead.

Hollow flat spot above the nose.

No hollow flat spot above the nose.

Feminizing the forehead

Keep in mind that the bridge of the nose and the forehead are best done together, because after removal of the frontal bossing it is important for the upper nose to integrate smoothly with the new 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 called the “supraorbital rims”. These are solid bone and can simply be filed down.

The section of bossing between the eyebrows (the glabella) 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.

frontal bossing reduction

Classification Ousterhout

Dr Ousterhout, the father of Facial Feminization Surgery, describes mainly three types of forehead operations: “Type I”, Type II”, “Type III”. He also mentioned a type IV operation for patients with a malformation of the forehead, but that is only in the rarest of cases.

Type I

Type I procedure is performed with patients only having a small amount of brow bossing, very thick bone or no frontal sinus at all. In this case the excess amount of bone is just burred away, without entering the frontal sinus. 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 reasonable result with this technique.

frontal bossing reduction type I

Type II

Dr Ousterhout describes a technique that he uses when the projection angle between the nose and the forehead is already satisfying. Only the concavity after the bossing he will address in that case. He fills the concave area above the bossing with methyl methacyrlate. As we have good results with our combined type I – type III procedure, we choose not to use this technique because by introducing a foreign material into a body there is always a risk of infection.