The forehead is another area where we find significant differences between the sexes. Males quite often have a larger and more pronounced forehead. A genetically born male can also have another common feature in the form of a horizontal ridge located just above the eyebrow level. This area is referred to as the “brow ridge” or “brow bossing.” The female forehead doesn’t usually have these masculine characteristics. To address this issue, Dr. Cardenas offers Forehead Bone Remodeling.
Most patients seeking feminization of the forehead have what’s often referred to as a Type 3 forehead. This means that the more masculine projection in the lower-center of the forehead is mostly due to a large frontal sinus covered by bone. Although the bone could be shaved down to a certain degree, the primary cause of the forehead projection in this area is the sinus. To reduce this masculine projection in our FFS patients, Dr. Cardenas removes a small section of bone covering the sinus and then remodels it so that the bone section can be returned to the forehead in position that is more setback than before.
A small percentage of patients either have no frontal sinus or have a sinus that is covered by an unusually thick bone structure. For this minority of patients, a bone burring technique is sufficient to achieve feminization of the lower-center of the forehead. It’s not necessary to remove and return the small section of bone described for the Type 3 patients.
Forehead Bone Remodeling involves a lot more than the center of the forehead. To the left and right of this area, you have the orbital rims which tend to be more pronounced in men. To address this issue, the orbital rims are contoured using a bone burring technique. In addition, Dr. Cardenas occasionally uses a bone ostectomy technique to cut and remove a small section of bone below the eyebrows. This is done when he observes that the ostectomy technique would enhance the lifting of the eyebrows. However, in most cases bone burring is sufficient.
Finally, Forehead Bone Remodeling addresses the vertical height of the forehead because taller foreheads are usually seen to be more masculine. To reduce the vertical height, Dr. Cardenas raises the eyebrows and lowers the hairline.
Question: How does Dr. Cardenas know whether or not to remove and remodel the section of bone covering the frontal sinus?
Answer: Once the incision is made along the hairline and access to the forehead is achieved, a technique called transillumination is used. This involves a bright surgical instrument which allows Dr. Cardenas to view the shape and size of the frontal sinus and the bone covering it. For most patients, he observes the Type 3 forehead which requires the removal and remodeling of a section of bone. However, if he sees that the patient has an uncommonly small or non-existent frontal sinus covered by thick bone and that the same result can be achieved with the bone shaving technique, he will proceed with that approach.
Question: Can you summarize what is included with Forehead Bone Remodeling?
Answer: In short, the reshaping of the bone in the lower area of the forehead is done. The center of this area is examined with transillumination and the correct technique chosen as described above. The eyebrows are raised. The hairline is lowered unless excessive hair loss prevents this or the patient doesn’t want a conventional hairline advancement. Example – Some patients might want only the edges of their hairline advanced in order to help remove signs of male pattern baldness.
Question: What about the upper part of the forehead?
Answer: The vertical height of the forehead is usually reduced with the lowering of the hairline and the raising of the eyebrows. However, we occasionally have patients that want their temples softened or upper forehead shaped a bit. Dr. Cardenas has developed a fat infiltration technique for these purposes. However, this is a separate procedure and is not considered part of Forehead Bone Remodeling.
SURGERY PERFORMED ON THE FOREHEAD
BY DR. LAZARO CARDENAS