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The eyes, eyebrows, and forehead are likely the most important areas in presenting gender. There are noticeable differences in hairline pattern, eyebrow shape, size of the eyes, and shape of the forehead between men and women.
Forehead contouring & reduction surgery is one of the most dynamic and advanced forehead surgeries offered by Dr. Spiegel. The technique is very powerful with the ability to truly transform the appearance of the forehead. Masculine foreheads typically have a heavy bony ridge in the area just above the eyes and beneath the eyebrows. This is often referred to as “brow bossing”. Forehead contouring & reduction surgery involves shaping the forehead bones and orbital bones (bones around the eye) to remove the ridge, open up the appearance of the eyes, and create a more naturally feminine, softer appearance.
Beginning with mastery of the techniques of forehead surgery employed by surgeons of the past, Dr. Spiegel has used new technologies to innovate a method of shaping the hairline, forehead bones, eyebrows, and eye region that is safe and effective and provides remarkable results.
To access the forehead bone, a fine incision is made along the hairline from temple to temple. The incision is done in front of the hairline so that Dr. Spiegel can preserve all of the hair you have while advancing the scalp and hairline to a more feminine position. Following surgery some patients will elect to have a few hairs transplanted in front of the new hairline although in most cases, this is unnecessary. Through this incision Dr. Spiegel is able to reshape the bones around the eye and forehead to a natural feminine shape. A number of different techniques are needed in order to get an optimal result due to varying anatomy. Utilizing his expertise in sinus surgery, Dr. Spiegel is able to reposition the forehead bones while minimizing any disruption of the sinus function.
Some patients have forehead bones that are very thick and using a burr to thin the bone is enough to get the desired result. However, this is quite rare. In most cases, patients have bone that varies in thickness depending on the area. Dr. Spiegel begins most cases by burring down the bone until he gets close to the sinus cavity. Once he determines where the sinus cavity is located he removes a small area of bone above the cavity but he is careful not to cut into the area. Then he reshapes the small fragment just enough so it fits back into the forehead but sits farther back into the cavity – removing the heavy brow bossing and giving the forehead a flatter, more feminine appearance.
Once the forehead is shaped to its desired position and balanced with the rest of the face the small fragment is held in place snug with the body’s natural tissues, in some cases with a tiny titanium screw, and a special “bone cement”. This “cement” is the patient’s living bone ground down to a smooth paste and laid over the broken bones helping the bones heal rapidly in their new position.
At this point Dr. Spiegel is able to shape the hairline by advancing the scalp in areas where it is receded. A natural result is obtained which typically eliminates the need for any fat grafting in the temporal area. At the same time, Dr. Spiegel carefully lifts the eyebrows to their natural feminine position on the new forehead. The look is subtle and not overly pulled; rather it gives patients a beautiful result highlighting their eyes and new, smooth forehead.
For those who don’t need scalp repositioning, forehead contouring and brow lifting can be achieved through an incision that is nearly invisible. Additionally, for some, minimal brow shaping and brow lifting is all that is needed and this can be done with an endoscopic approach. Dr. Spiegel is expert at use of surgical endoscopes and has published papers relating to their surgical use.
Following surgery, a soft dressing is placed around the forehead and left in position overnight. The dressing is then replaced with an ace bandage for 7-10 days after surgery. The bandage reduces swelling and helps protect the area. Patients do experience extensive bruising and swelling immediately following the surgery. This swelling improves quickly over the first few days. Most patients spend one night in the hospital and return to their home or hotel the next day. Pain is commonly mild and well managed with prescription pain medication. Showering and gentle washing of the hair are permissible but must be done with care. It is important to towel dry and comb your hair towards the incision line (so as not to stretch it or pull at it) and to only use a blow-dryer on the “cool” setting (unheated).
Sutures are removed 6-8 days after surgery at a first post-operative visit with Dr. Spiegel. Most patients feel well enough to return to work 8-9 days after surgery; however, if the surgery is combined with multiple procedures then it may be advisable to wait two weeks before returning to work. Strenuous activity (causing sweating or rise in blood pressure) and light exercise should be avoided for at least two weeks. More vigorous exercises like yoga, pilates and running should be avoided for 6 weeks.
Infection after surgery is extremely rare; however, antibiotics are used to avoid any potential problems. Swelling and bruising on the forehead and around the eyes is common. The majority of this swelling and bruising will last under two weeks; however, it is normal to having some minor swelling even after several months. After one week cover-up makeup is allowed to mask any residual bruising. Sensitivity loss at the top of the head is common for several weeks after surgery and not one patient has experienced permanent sensitivity loss. Most patients regain sensitivity about 2-4 months after surgery; although some patients have waited a bit longer – about 8-10 months.
Is forehead contouring for you? Talk to Dr. Spiegel about your options with this transforming procedure! 617-566-3223
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