What makes a forehead masculine?

Male

  • A (protruding) eyebrow arch
  • A flat spot between the eyebrow arches
  • A receding, sloping forehead

Vrouwelijk

  • (Almost) no eyebrow arch
  • A flat spot
  • A more vertical, rounder forehead
A male skull (left) vs. a female skull (right)

Feminization of the forehead

Brow bone reduction is a procedure in which the eyebrows are filed and the bone is surgically altered:

  • Strong bone such as eyebrow arches can simply be filed away (~ 'shaving').
  • Between the brow ridges is an area called the frontal sinus. Because the sinus is hollow, it is more difficult to file or shave away the bone there. The bone plate in front of the sinus cavity is removed, reshaped, and put back in place with small titanium screws to hold the bone in place while it heals. Alternatively, the sinus can be filled with bone cement (Dr. Bart van de Ven prefers this).
The central part of the brow ridge often cannot be shaved down because of the sinus cavity that lies behind it. If the bone is filed away over the sinus cavity, a cavity or hole is created.

How your brow bone and forehead can change depends on:

  • the prominence of your brow arch;
  • the thickness of the wall of your sinus cavity;
  • the size of your sinus cavity and forehead in general.

4 types to reduce the eyebrow arch

According to American FFS pioneer Dr. Douglas K. Ousterhout, four types of brow arch reduction procedures can be performed to achieve the desired results.

Type 1 — Filing or shaving (~'shaving')

  • Suitable for people with a very small or absent frontal sinus cavity and a thick frontal sinus wall. Only 10% of our patients have this type of forehead. In this case, the excess bone can simply be filed or planed away.
  • Possible complications: if the bone is so thin at the end of the procedure, a hole can still develop in the frontal sinus wall after weeks/months. If the bone has too little blood flow, it can disappear. However, if the hole is small and no visible hole develops, this is not a problem.
Type 1 – Filing or 'shaving'

Type 2 — Planing and filling

  • This type can be performed when one is already satisfied with the angle between the nose and the forehead. In that case, only the hollow behind the bone edge needs to be addressed.
  • The planing is minimal and the hollow area above the brow arch is filled with bone cement (see yellow and orange in the sketch).
  • Possible complications: although the new forehead is smooth, it may appear as a 'heavy', dolphin-like forehead that protrudes slightly compared to the 'ideal' female forehead line (see red line on the sketch). Therefore, this is not the preferred type to perform in our clinic.
Type 2 – Planing and filling

Type 3 — Forehead reconstruction

  • This type is usually preferred because most patients have a medium to large sized sinus.
  • In this procedure, the anterior wall of the frontal sinus bone is removed, remodeled and replaced with titanium screws or the sinus is filled with bone cement. If necessary and possible, the surrounding bone is also corrected.
  • Possible complications: changes in the shape of the sinus cavity can feminize the resonance (amplification of vocal sounds). (Semi-)professional singers who wish to maintain their masculine resonance should be aware of this risk and weigh the pros and cons.
Type 3 – Forehead reconstruction (before surgery)
Type 3 – Forehead reconstruction (post-surgery)

Type 4 — Forehead reconstruction and filler

  • If a patient has a sloping, receding or angular forehead, a type 3 procedure may not be sufficient. Additional filling with bone cement may be used to achieve the desired forehead shape.
  • Possible complications: The same complications can occur as with the previously mentioned procedures.
Type 4 – Forehead reconstruction with filling (before and after)

How exactly is the procedure performed and what can you expect?

Discover the entire process on our website and don't forget to ask Dr. van de Ven for additional details if anything is unclear. He will be happy to explain the process and what you can expect.