Facial Feminization Surgery (FFS)
and Forehead Bossing Surgery

A long forehead is generally acceptable for the male, but not the female. Male foreheads often have a heavy bony ridge just above the eyes in a line beneath the eyebrows, which is called brow bossing.

Forehead bossing surgery is a facial feminization surgery that can involve brow shaving or surgically altering the bone. In severe cases, forehead bossing involves taking out the bone, reshaping it, and placing it back in the skull. In these cases, forehead bossing requires small titanium wires or screws to hold the bone in place while it heals. In many other cases, the bone can be reshaped without removing it from the skull, eliminating the need for titanium bolts or screws.

Forehead bossing can involve an implant or filler to round out a flat forehead, giving a more feminine appearance. Porous materials or acrylate fill are used for type of forehead bossing to emulate bone.

The Procedure

• To access forehead bones, an incision is made across the top of the scalp from ear to ear. The incision may be done at the front of the hairline to advance the hair at the same time.
• Forehead skin is pulled forward to reveal the bone.
• The solid bone, known as orbital rims, are shaved down
• Bone over the frontal sinuses is more difficult and may require a different procedure
• Shaving—If the bones over the front sinuses are thick enough, they can be shaved down to give a flatter and more female contour
• Implants and Fills—If shaving alone is not enough to achieve the desired result, especially if the bones over the sinuses are too thin to be shaved down, a bone-filler may be used to fill in hollow areas around the forehead.

• Forehead reconstruction—This is the most complex and invasive forehead bossing surgery. The orbital rims are shaved, but the one over the frontal sinuses is removed, re-shaped and set with wires or titanium screws. This forehead bossing technique is very powerful and can transform a severely male forehead into the normal female ranges.

• An alternative forehead bossing technique involves shaving the bones over the sinuses thin enough so they become flexible and can be pressed into the correct position.

The Recovery

• Most patients will spend one night in the hospital following surgery.
• A dressing is placed around the forehead after surgery, and left in place during the first night. After than, an ace bandage is typically worn for one week after surgery.
• After removing the dressing, daily showering and gentle washing of the hair should be done carefully for a few days.
• Pain may occur for a few days following surgery.
• Many patients can go back to work within one week following surgery.
• Avoid physical activity that causes sweating or a rise in blood pressure for eight days.
• Sutures and staples are generally removed within one week.

Possible Complications

• Infections are extremely rare, but antibiotics are used to avoid potential infections.
• Swelling and bruising may occur around the eyes, but will dissipate within ten to twelve days
• Forehead numbness may last several weeks to possibly years
• Nerve injury occurs rarely