Forehead Aesthetics Have A Significant Impact

The eyes, eyebrows, and forehead are among the most important areas for youthfulness, attractiveness, familiarity, and, importantly, gender identity. There are noticeable differences in hairline pattern, eyebrow shape, size of the eyes, and shape of the forehead between masculine and feminine faces. Since the face is so vital in first impressions, it is important to have the forehead be consistent with your gender and sense of self.

What is Forehead Contouring?

Forehead contouring and reduction surgery is one of the most powerful ways to improve your appearance, soften or feminize the face, look youthful, and feel confident. It is one of the most unique surgeries offered by the expert team of double board-certified plastic surgeons at The Spiegel Center in Newton, Massachusetts. In fact, practice founder Dr. Jeffrey Spiegel has innovated methods of shaping the hairline, forehead bones, eyebrows, and eye area that provide remarkable results and are imitated, but never equaled by surgeons worldwide. 

Masculine foreheads typically have a heavier bony ridge in the glabellar area just above the eyes and beneath the eyebrows. This is often referred to as “brow bossing.” Forehead contouring and 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. Or, for those who identify as men but don’t want to look as angry or threatening, the brow ridge can be reduced but not eliminated. And, for those who want a more masculine look, the brow can be enhanced.  

What Happens During The Procedure?

To access the forehead bone, a fine incision is made along, or within, the hairline. When you want to bring the hairline forward, the incision is done in front of the hairline so that the surgeon can preserve all of the hair you have while advancing the scalp and hairline to a more feminine position. This allows us to reshape, round, and refine the hairline. Or, the incision can be made on top of, or towards the back of the head where it is well hidden. Following surgery, some patients will elect to have a few hair grafts transplanted in front of the new hairline for further refinement and camouflage of incisions.

Through this approach, your surgeon is able to reshape the bones around the eye and forehead into the desired shape. Several different techniques are needed in order to get an optimal result since specifics in facial anatomy vary from patient to patient. Utilizing their incomparable expertise, our surgeons reposition the forehead bones while minimizing any disruption of the sinus function. The Spiegel Center has published many of the key research papers describing the safety, effectiveness, and nuances of the procedure. 

Forehead surgery has been classified by others into different types. Type III (Type 3) forehead surgery is where the bone is reset to a new, more desirable position. Type I (Type 1) is where excess bone is removed without resetting any bone. Most patients need a Type III surgery procedure, but your surgeon will be able to guide you as to what is appropriate for you. We are proud to have discovered that forehead surgery is the most important procedure for facial feminization and set the industry standard of the safest ways to perform these powerful procedures.

Forehead ContouringBefore & Afters

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A Careful And Meticulous Approach

Some patients have very thick forehead bones, and using a burr to thin the bone is enough to get the desired result. In most cases, patients have bones that vary in thickness. Our surgeons determine where the sinus cavity is located and then work over and around it to get the right shape. This may involve removing bone, adding bone, or resetting bone. This removes the heavy brow bossing and gives the forehead a smoother, less protuberant, more feminine appearance.

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Securing Everything Into Position

At The Spiegel Center, we help you achieve your goal as efficiently (with the least amount of surgery) as possible. Similarly, we do everything as naturally as possible. Forehead surgery involving a forehead setback (Type III) done at The Spiegel Center involves only a minimal amount of implanted material for fixation.  In some cases, a tiny titanium screw and a small bracket are used.  

We’ve shown in important medical publications that using the minimum amount of implanted material is as effective as using more, and much safer for the patient. Additionally, we use a special “bone cement” made from some of the removed bone. This living bone is fashioned into a smooth paste and laid over the repositioned bones, helping the bones heal rapidly in their new position. This is so effective and natural that a CT scan in the future may not reveal identifiable signs of prior surgery.

At this point, your doctor is able to shape the hairline by advancing the scalp in areas where it has receded. At the same time, your doctor carefully lifts the eyebrows to their natural feminine position on the new forehead with your input. Eyebrows can be positioned according to your personal style and preferences. But, in all cases, the look is natural and not overly pulled; rather, it gives patients a beautiful result highlighting their eyes and new, smooth forehead.

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Alternative Approaches For Less Intensive Corrections

For those who don’t need scalp repositioning, forehead contouring, and brow lifting can be achieved through a nearly invisible incision. For some, minimal brow shaping and brow lifting are all that is needed, and this can be done with an endoscopic approach. Our team of physicians are expert in the use of surgical endoscopes and their surgical use.

The Day After Surgery

Following surgery, a soft dressing is placed around the forehead and left overnight. The dressing is then replaced with an ace bandage for several days after surgery. The bandage reduces swelling and helps protect the area. Patients do not typically experience much bruising or swelling following the surgery. Any swelling that is present improves quickly over the first few days. Most patients go right home, or to a hotel, immediately after the procedure and feel well.

Pain is commonly mild and well managed with acetaminophen and a backup 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).

The First Week After Surgery

Sutures are removed 6-8 days after surgery at a postoperative visit with your surgeon. Most patients feel well enough to return to work 8-9 days after surgery; however, if the surgery is combined with multiple procedures, it may be advisable to wait two weeks before returning to work. 

Alternatively, if you can work remotely, you may feel up to work just a day or two after surgery.  Strenuous activity (anything that causes sweating or a rise in blood pressure) and exercise should be avoided for at least two weeks. More vigorous exercises like aerobics, weight lifting, and running should be avoided for 6 weeks.

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Potential Side Effects

Infection after surgery is extremely rare; however, antibiotics are provided to avoid any potential problems. Swelling and bruising on the forehead and around the eyes are common but rarely significant. The majority of this swelling and bruising will last under two weeks; however, it is normal to have some minor swelling persist longer.

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, but no patients have experienced permanent sensitivity loss or nerve injury.

Schedule A Consultation

Is forehead contouring for you? To set up your consultation with one of our double board-certified plastic surgeons, contact The Spiegel Center in Newton, Massachusetts, today and schedule an appointment. You’ll be glad you did, so don't wait!

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