Brow bone reduction
Last updated date: 17-Jul-2023
Originally Written in English
Brow Bone Reduction
A protruding forehead is an essential masculine feature on the face of a man. For this reason, most women and few men who have a protruding forehead opt for remedies that can help reduce or eliminate such a forehead. In such cases, the best method to undergo is the brow bone reduction procedure.
What is a Brow Bone Reduction Surgery Like?
An incision is made, either within the hair, where it is effectively concealed right immediately, or just in front of the hair, allowing for further hairline correction. Scars from hairline incisions are usually difficult to notice after a few months, but they can be rather apparent at first.
The brow bone and orbital rims are decreased by this incision. The high brow bone can be softened and rounded, and the eyes can be made to seem brighter and more open. We can also raise the brows and shape them to produce a more feminine brow curve.
Brow bone reduction can also be to as forehead contouring. Neanderthal forehead surgery, or forehead reshaping surgery. It's an effective procedure capable of transforming a prominent male forehead itnto the average feminine range. This approach is one of the main facial feminization surgery procedures. In most cases, forehead contouring is done along with hairline lowering or brow lift due to surgical site location. This results in an excellent aesthetic look.
The upper section of the face has the greatest impact on beauty and femininity. The objective of brow bone reduction is to shape the bone over the eyes so that light can highlight the upper face. It is usually done in conjunction with bone work, brow lift, and hairline lowering.
A male forehead has a more pronounced ridge of bone immediately above the eyes, known colloquially as the "brow bone." A feminine forehead has a softer, softly sloping look.
People don't know it, but the brow bone is one of the facial characteristics that identify a person's gender.
Brow ridges are the areas of the brows that are not covered by the full brow. Their lower border sinks inward to form eye sockets, while their top margin joins with the frontal bone to form a portion of the forehead. When viewed from the side, the brow ridges are the most prominent feature of the forehead.
In most situations, their morphology is created spontaneously; nevertheless, a few factors like trauma or endocrine disorders might influence their osteogenesis.
Because protrusive brow ridges may make people look masculine or make their eye sockets appear somewhat deeply sunken, most patients would contemplate brow ridge reduction to grind off the rough surface or protrusive bones, smoothing the contour of the brows and making the forehead look full and round.
Types of Brow Bone Reduction
There are four forms of brow bone reduction that surgeons often use depending on the prominence of your brow bone, the thickness of your frontal sinus wall, the size of your sinus, and your forehead in general. The most suitable type to use is normally based on the brow bone prominence, the width of the frontal sinus wall. This also includes the general size of the forehead and frontal sinus.
The surgery can be coupled with a brow lift or hairline advancement/lowering surgery. The position of the incision, or scar, will be determined by your forehead anatomy, hairline, and whether or not you are undergoing additional treatments at the same time. Hairline lowering/advancement surgery is typically performed along with brow bone reduction surgery.
Addressing the frontal sinus is critical to achieving the greatest results with this treatment. This sinus is a pocket of air that stretches from the top of the nose to the brow. The majority of people require more than just bone shaving.
Thus, the types of brow bone reduction include;
Type 1 (Shaving)
Some people have a relatively smaller sinus and a broad frontal sinus wall. In such a situation, the surgeon will bury the extra bone. This approach is referred to as a ‘type 1 forehead.' Most surgeons today will only bury away a little amount of bone, a process known as feminization of the forehead. However, only a limited number of patients will benefit from this technique, especially people with minor bossing or sinusitis.
Regardless of what some surgeons may say, it is usually impossible to turn a male forehead into typical female ranges through burring alone. This is due to the frontal sinus.
Type 2 (Shaving and filling)
This approach comprises a partial indication and is often used by surgeons who do not conduct forehead reconstructions. It is effectively useful if the projection angle in the nose and the brow is already satisfactory. In such a scenario, just the concavity at the back of the bossing needs to be addressed. Bone cement will be used to cover the concave space on top of the bossing.
When a type 2 brow bone reduction is done when it is not necessary, a ‘heavy' dolphin-like forehead is generated. Although the new forehead is smooth, it bulges forward when compared to the "ideal" female forehead line.
Type 3 (Forehead reconstruction)
The most commonly used forehead recontouring technique is this type 3 procedure. The procedure involves detaching the front wall of the frontal sinus bone, remodeling it, and placing it back.
Sometimes it is necessary to use a combination of forehead reconstruction and some filling with bone cement to get the desired forehead shape. We use the bone cement more and more often to get the exact result he wants.
Type 4 (Forehead reconstruction and filling)
To achieve the desired forehead profile, a combination of forehead reconstruction and bone cement filling may be necessary. Surgeons use bone cement to obtain the results that one wishes to have.
Male and Female Forehead Difference
Sexual dimorphism refers to variations in appearance between males and females of the same species, such as changes in color, shape, size, and structure, induced by the genetic inheritance of one or the other sexual pattern.
There are three most essential differences when it comes to the male and female forehead. They include;
- The brow bossing: Men's and women's foreheads differ primarily. Men usually have a ridge of bone all along the upper rim of the eye sockets. This is known as the brow bossing or brow ridge. On the other hand, female foreheads have small or sometimes no bossing at all.
- Flat spot: A flat area is sometimes noticeable between the ridges of both eye sockets. Since women lack these ridges, the flat spot on the eye socket ridges is absent.
- Forehead slope: In men, the general forehead angle tends to be steeper, while the angle between the nose and forehead is sharp in lateral look due to the brow ridge. Women, however, have an extra vertical look of the forehead in sideways view since they lack the brow ridge. Also, the angle between the brow and nose is broad.
- While brow bone reduction may be performed on both men and women, the techniques utilized may differ depending on the amount of brow bone reduction required. Most men who consider and undergo brow bone prominence reduction do so because they are too large and have a major effect on the judgment of their facial appearance. Strong male forehead bones can give one a 'Neanderthal' or hypermasculine look, making them appear enraged and/or menacing.
- While the requirement for and method for a bone flap setback technique is simple in males, the placement of the incision and the resulting scar are important factors as an acceptable compromise. Many men have short hair, receding hairlines, or are entirely bald, and using a conventional coronal incision must be extensively addressed before surgery. Some men may believe that such a sacrifice is worthwhile.
- However, when given the option, some men may choose not to have the surgery. A brow bone reduction can be performed more directly in guys with acceptable deep horizontal skin wrinkle lines or scars. A nerve-sparing method may typically be used without impairing the capacity to remove and replace the bone flap.
How Brow Bone Reduction Surgery Improves Overall Appearance?
- A person’s forehead accounts for nearly 35 to 40 percent of the overall facial surface area. It controls and aesthetically influences all the other facial features. Therefore, if it gets out of balance in any way, then the entire facial form will be affected. As a result, you can feel that your brow and forehead regions are too wide or prominent. This causes an overhanging impact on the eyes.
- Generally, the brow can be asymmetrical in form, look too masculine or feminine for your particular gender identity. Also, it can be out of proportion with all the other facial factors in a certain manner.
- In trans-women and cisgender women, the forehead reduction procedure enhances the facial outline. This is by giving more harmonious and womanly flexibility with how the brow aesthetically correlates with other features. The operation also shapes the forehead as well as the fragile bones in the eye socket. This reduces the bony ridge around the excessively prominent forehead. Brow bone reshaping and reduction both tend to free up the skin, transforming and feminizing the upper facial region.
- The major challenge with Trans and cisgender males can be that the forehead does not appear masculine enough. In such situations, the surgeon can suggest forehead augmentation and lengthening instead. This is based on the actual facial characteristics and the desired effect.
Good Candidates for Brow Bone Reduction
If you are a generally healthy adult who believes that your forehead is detrimental to your appearance, you are an excellent candidate for forehead reduction or eyebrow reduction. You might be an ideal candidate for eyebrow reduction surgery if you;
- Are an adult
- Have excess protruding brow ridges or forehead which makes you look more masculine
- Want to change male features and sculpt a feminine forehead appearance
- Have uneven frontal surfaces or a protruding regional bone
- Have eye sockets that are sunken or crossed canthus or an eye tail that is droopy due to protruding brow ridges
- Need facial reconstruction surgery
Neanderthal Forehead Condition
The forehead is one of the most prominent features of the face, accounting for up to one-third of its overall surface area. However, there are significant variations between males and females with regard to the frontal hairline.
Furthermore, the base of the forehead, which the brows and the brow bones (ridges of skull bone) outline, reveals significant facial variations between the sexes. The form of the bony forehead and the eminence of the brow ridges (called neanderthal forehead ridges) helps distinguish the masculine from the feminine look.
However, the bone ridge that runs over the forehead over the eyes (brow bossing) can go beyond the acceptable ranges of brow protrusion. This results in the condition of excess masculine brow called Neanderthal forehead. Most forms of frontal brow bossing are classified as Neanderthal. For example, a protruding forehead, a sloping forehead, and a smooth forehead are all termed as neanderthal.
Causes of Neanderthal Forehead
Acromegaly, a severe condition that causes excessive production of growth hormone, is a prominent underlying cause. Individuals with this condition have overly larger than normal hands, feet, jaws, and skull bones.
On the other hand, there are many other possible causes of Neanderthal Forehead or frontal bossing, including:
- Taking anti-seizure medication called trimethadione while pregnant
- Abnormal forehead or skull growths
- Specific forms of anemia that can result in increased yet ineffective red blood cells production by the bone marrow
- Basal cell nevus syndrome
- Cleidocranial dysostosis
- Congenital syphilis
- Crouzon syndrome
- Hurler syndrome
- Pfeiffer syndrome
- Rubinstein-Taybi syndrome
- Russel-silver syndrome
What Does the Brow Bone Reduction Procedure Involve?
Each person has different expectations when it comes to forehead contouring. Due to this, the operation tends to differ from one patient to another. However, in general, it entails reshaping the hairline, brow bones, forehead ridge, and bones across the eye sockets. These procedures aim to give you a more feminine look.
The surgeon will start by creating an incision. It can be either in the hair, where it is completely concealed straight away or right in front of the hair, allowing for further hairline changes. Scars from hairline incisions are normally difficult to detect for a few months. However, they can be more noticeable at first.
The surgeon will reduce the brow bone and orbital rims via the incision. The upper brow bone can be rounded and also softened, while the eyes can be made to look bright and more open. The surgeon can as well lift or raise the eyebrow bone to form a better womanly brow curve.
To obtain the most feminine forehead form in the patients, the bone front wall needs to be eliminated. The surrounding bone is also reduced while replacing the front wall (type III procedure). The brow bone is highly dense in a small number of patients. Hence, simply shaving down the bone (type I) can result in the appropriate feminine contour.
Generally, it is vital that you seek a qualified surgeon. He or she should be capable of performing a bone setback operation instead of only shaving down the bone for this treatment.
What Happens During Brow Bone Reduction Surgery?
Brow bone reduction surgery is an operation that is normally carried out when the patient is under general anesthesia. To help lessen pain, discomfort and bleeding, the surgeon can use a local anesthetic in the forehead region.
Before the surgery
- Because the brow ridges and frontal bone have thinner structures than other facial bones and are located above the hollow frontal sinus and attached to the meninges of the skull, patients should have a skull X-ray or more precise 3D CT scanning done prior to surgery to accurately predict the extent and range of bones that can be reduced and to avoid potential postoperative complications.
- Because the thickness differential between the brow ridges and frontal bones ranges from 2 to 5 mm, preoperative X-ray scans should be used to estimate the amount of brow bone reduction required. The removal of 3 millimeters of bone is believed to be successful in most cases.
- The sculpting and adjusting of bone surface forms are also worth noting. Two methods are often used. If the prominence is only at the inferior or lateral margin of the brow bone, a 1 cm incision will be made on both sides of the lower edge of the eyebrow for shaving bone reduction; however, if the prominence is large-area or if the concurrent frontal bone reduction or even a forehead lift is required, a distal incision will be made medial to the upper scalp hairline for shaving bone reduction.
- The surgery isn't difficult because neither osteotomy nor bone screw fixation is required, there is no risk of intraoperative bleeding, making this a very safe osteoplasty. However, the bone thickness should be monitored during the procedure to avoid excessive bone loss, which might compromise structural strength or result in a sunken look.
- Given the difficulty of deciding where to make the incision in many men, an alternative ‘brow bone reduction' approach should be considered prior to surgery. The slope of the forehead above the brow bones should always be taken into account.
- Preoperative computer imaging is required to show the patient what modifications in brow reduction, forehead augmentation, or both operations combined will look best.
- A false diagnosis (pseudo brow bone protrusion) and an unneeded brow bone reduction operation can be avoided with a preoperative profile examination. Aside from the cosmetic outcome, this preoperative consideration is important since a forehead augmentation may be done much more quickly and with less scarring, especially when a computer-designed forehead implant is utilized.
- At the least, the man who is reasonably concerned about unpleasant visual scars may choose for a camouflage forehead augmentation, especially if they are unable to discern a substantial difference between the two projected operation outcomes.
During the operation
During the main procedure, the surgeon will conduct the operation in several steps, including;
- A surgical skin marker may be used to mark the hairline and region of the forehead that will be cut. Significant care is taken to make sure that the cut in the hairline does not alter the nerves and hair follicles.
- A local anesthetic is used to numb the whole forehead, starting from the hairline towards the brows above.
- The surgeon creates an incision in the marked region of the brow and hairline, also referred to as the pretrichial incision. After that, he or she will gently lift the skin from the connective tissue under and carve out the region indicated for removal.
- The top incision in the hairline is then pushed down to connect the forehead incision. This seals the gap and narrows or shortens the brow.
- The surgeon will then suture the skin together, so that scar formation is minimized and is almost entirely obscured by the hairline as the hair regrow.
You should, however, note that brow bone reduction surgery minimizes the height of the forehead and can alter the overall look of the eyebrows. However, it does not always lift the eyebrows. When necessary, the surgeon can perform a separate surgical procedure, known as brow lift, at the same time as the brow bone reduction.
- The wound is concealed inside the scalp and is difficult to detect.
- Will correct any unevenness in the brows or protrusion of the brows.
- It Will help to enhance the appearance of sunken eye sockets produced by prominent brow ridges.
- Will enhance the full and round features, as well as the feminine line of the brow.
- Will alter masculine face features such as protruding brow ridges.
What to Expect After Brow Bone Reduction and Recovery?
Most brow bone reduction procedures are conducted on an outpatient basis. However, some people might be required to remain in the hospital overnight for further monitoring and observation. The physician will remove the sutures on your first post-operative appointment after five days of the surgical procedure.
Swelling and bleeding are typical side effects that can last for two weeks, with moderate swelling lasting for two months. Also, brow bone pain is normal among patients, but it is easily handled and controlled with appropriate aftercare. After a week, patients will return to their normal schedule. However, one should refrain from certain strenuous activities for up to one month.
For a more natural impact, the surgeon will curve the hairline scar at an irregular angle. It will be red and prominent at first, but it will be less evident after about six weeks as hair begins to grow over the fine scar. It would take about a year for the scar to mature.
The visibility of the scar will depend on the hair density at the back of the hairline. The scar won’t be easily noticeable if the hair is denser as the hair roots that have been pressed on beneath the scar grow in the scar. For a person with thin hair, the scar could be more visible as you pull your hair backward.
The white skin stitches will dissolve in about a week or two. If the sutures are still in the skin after two weeks, they will break when pulled by the finger.
Temporary numbness is likely to occur in any region where the surgeon performs the bone work. Based on where the operation was conducted, these areas may include the forehead, scalp, jaw, chin, or cheeks. This arises when the soft tissue separates from the bony area.
See also Square jaw and square chin
Numerous small nerves can be damaged, and it might take a few years for the affected regions to recover. It is not uncommon for the recovery period to take up to 18 months. Instead, it is normally a relatively shorter time, although you might not feel the same as you did before.
Factor to Consider During Preoperative Evaluation of the Brow
When it comes to preoperative evaluation of the forehead, both you and the doctor will discuss the major elements. The cone-beam CT scan (CBCT) on the facial bones is conducted on the patient in the doctor’s office. This is a significant aspect of the assessment and is normally before the facial bone procedure.
The main preoperative elements to consider include;
The central lower forehead (glabellar region): When making plans and executing brow bone reduction, the glabellar the major area of concern. This region is very conspicuous, hence forming a shadow in the eyes. Therefore, contouring through setback is an essential part of brow bone reduction female and facial feminization surgery in general.
Superior orbital rims: These regions are also known as supraorbital or brow ridges. Reduction of the bone within this region removes the deep-set eye look, giving the eyes a better-enlightened appearance.
Supraorbital region: The region directly on top of the superior orbital rims is shaved to minimize the bony conspicuousness. Shaving also reduces the downward angle of the forehead, particularly in 3/4 outlook. This results in a better oval-shaped, womanly contour.
The temporalis muscle and the bony ridges: Certain patients can gain from the general reduction of the forehead width. This is accomplishable by decreasing the temporalis muscle and the bony ridge at the insertion via the temporal bone.
Brow bone reduction cost
The brow bone reduction cost often varies based on the condition and the extent of the changes to make to achieve a satisfying outcome. Actually, it is nearly impossible to estimate the average financial obligation required, inclusive of the surgery consultation.
Nevertheless, if you are considering the cost of the surgery, then these essential factors will be helpful;
- The present features including the extent to which you can need forehead reduction, reshaping, or contouring
- Any additional surgical procedures, such as hairline lowering or brow lift that may be necessary
- Any other pre-existing medical problems that could have an impact on the surgical operation
- Hospital specific charges
Alternative Options for Brow Bone Reduction
In case you are not a perfect candidate to undergo brow bone reduction, the physician can recommend other options, including;
- Brow lifting
A brow lift could be an option to brow bone reduction surgery if the forehead tends to be longer due to short brows. This technique involves lifting the brows higher on the face through muscle manipulation or eyebrow skin shifting. Raising the brows will make the forehead look shorter in some situations.
- Hair grafting
When the brow looks longer due to a high hairline, hair grafting or hair transplantation could be an option. This approach involves extracting hair follicles from the rear of the scalp and transplanting them along the hairline front. A hair grafting procedure can also be useful in shortening the brow.
Non-Surgical Alternative Options for Brow Bone Reduction
In spite of the surgical procedure's increased success rate, some of the patients prefer to accomplish their aesthetic objectives through a non-surgical method, including the use of fillers.
A botox brow lift, also known as Botox Neanderthal forehead, is a non-surgical option for brow bone reduction surgery. As with the surgical procedure, non-surgical intervention can also be associated with numerous side effects and complications.
Most patients, for example, report brow bone headache, numbness, and soreness. Chronic brow bone reduction side effects have been reported in rare cases. They can include breathing difficulties, drooping brows or eyelids, swallowing difficulties, and speech changes reported in rare cases.
Endoscopic Brow Bone Reduction
The endoscopic brow bone reduction procedure of frontal bossing refers to a safe and efficient minimally invasive approach. It’s associated with relatively less swelling and bruising. A concealed, unnoticeable incision can be created in the scalp near the hairline. This results in relatively small wounds that are impossible for the patient to detect. Eventually, this stimulates a much quicker recovery process and a short healing period.
However, this treatment approach is limited to a small number of people whose brow bone thickness enables noticeable change with a burring method. In order to produce aesthetically appealing results, the preferred bone thickness is at least 5 mm. hence, a 1 or 2 mm reduction would not make a significant difference. However, a 3 to 4 mm reduction can result in a noticeable decrease in the frontal bossing amount.
Potential Risks and Side Effects of Brow Bone Reduction Surgery
Every surgical intervention carries varying risks of complications. Therefore, the possible risks and side effects of brow bone reduction surgery are;
- Adverse effects and allergic reactions to anesthesia
- Bleeding during or after the operation
- Infection around the incision site
- Paresthesia (burning, tingling, or itching sensation) around the surgical area
- Scarring once the incision wounds heal
- Loss of hair in the place where the hairline was cut
- Asymmetry or uneven appearance
- Changes in the scalp feeling due to skin detachment from the bone during the procedure
- Non-satisfactory aesthetic outcome
- Decreased forehead skin sensation, which can be temporary or permanent in rare cases
- Double vision at certain angles
- Temporary frontal muscle spasm that forms a surprised facial appearance
Brow Bone Reduction Surgery FAQs
1. Is preoperative imaging needed?
Yes, preoperative imaging is needed.
2. What type of anesthesia is used?
Patients will undergo general anesthesia for this procedure.
3. How long is the surgery?
the procedure takes 2-3 hours.
4. Will there be an incision/scar?
The incision or scar will be hidden in the hairline.
5. Is a hospital stay required?
Yes, an overnight stay may be required.
6. What is the expected recovery?
Postoperative recovery usually takes 1-2 weeks, and most patients may expect to return to work after that time.
Brow bone reduction surgery is a cosmetic procedure that aims at shortening the forehead length. You might be an ideal candidate for this intervention if you feel or think that your brow is not proportionately broad for the face. It can be because of the eyebrows, hairline, and other facial features.
If you wish to undergo brow bone reduction, it’s essential to first discuss with the physician. Through this, they can quickly determine if you are eligible for the treatment procedure and the adjustments to make. You should also inquire about the possible risks of the operation, as this would help prepare in advance for any complications that might arise.