Brow Bone Reduction

Several small parts of the face help distinguish it as masculine or feminine. This is why facial feminization surgery (FFS) often includes a customized suite of surgeries to address different areas of the face. When it comes to the forehead and brows, many know that a brow lift can aid in feminizing the face. However, another commonly performed surgery during FFS is brow bone reduction. Dr. Javad Sajan at Allure Esthetic Plastic Surgery offers among the best brow bone reduction results in the region.

A brow bone reduction—also called a brow bossing reduction—involves reducing the projection of the bone in the glabella area. In some cases, Dr. Sajan may also reduce the projection of the brow bones extending horizontally. The surgical methods used can vary depending on the current size, projection, and thickness of the bone.

The surgery is most often associated with transgender women who want a more feminine-looking facial appearance. Women tend to have a brow bone that does not project in the glabella area and tends to project less overall. However, cisgender men and women sometimes undergo the procedure since some are born with a more prominent brow that they want to make smaller.

When performed for gender-affirming purposes, brow bone reduction is frequently part of a larger facial feminization procedure. Even if performed by itself, both brow bossing reduction and FFS are covered by most major insurances.

Benefits & Risks

As a gender-affirming surgery, brow bone reduction can be lifesaving. Still, patients and their providers must weigh the benefits and risks of the surgery. For many, this is a low-risk procedure performed on an outpatient basis. Others may incur more risk due to various factors.

First, let's look at the many benefits of brow bone reduction for gender affirmation. Some of the benefits and advantages include:

• Reduces gender dysphoria
• Sculpts a customized feminine facial appearance
• Easier to pass as the patient’s preferred gender
• Reduces projection of the brow bone and possibly the orbital rims
• Creates a flatter forehead
• Scars are hidden within or along the hairline
• Easily combined with hairline lowering, hair transplant, or brow lift
• Natural-looking results
• Personalizes the patient’s surgery to maintain their unique facial appearance
• Recovery comparable to general facial plastic surgeries
• Performed by an experienced plastic surgeon with years of experience performing gender-affirming surgery

Based on a patient’s unique facial anatomy, they may experience additional benefits from their brow bone reduction surgery. Like the benefits, the risks are also largely individual. The procedure carries the expected surgical risks as well as a few more specific to the surgical technique used. Some of the risks include:

• Infection
• Visible scarring
• Hair loss
• Prolonged side effects
• Skin necrosis
• Nerve damage
• Damage to the frontal sinus
• Complications due to general anesthesia

Major risks and complications are rare. You can reduce risks by going to an experienced provider, making sure to relay your medical history to Dr. Sajan, and following the provided recovery protocol.

There are a few surgical techniques that Dr. Sajan may use to perform your brow reduction. As part of the surgical planning, Dr. Sajan will ask that you get a CT scan at one of our offices. This allows him to see your full facial anatomy, including bone density, size of the frontal sinus, and more specific aspects of the anatomy. These results help him determine the right surgical approach. Below you can find more information about each brow bossing surgical technique.

Type I

A Type I brow reduction involves using a burr to shave down the brow bone. This is the only surgical technique used beyond making the initial incision. The Type I approach is the least invasive of all and is best for patients who need only a mild or subtle reduction. In this case, the frontal sinus is not altered or opened. This technique will not suit most facial feminization patients.

Type II

A Type II brow bossing technique uses a combination of shaving down the bone and filling the area above the shaved area with bone cement. This is indicated when the angle between the nose and forehead is already ideal. Minimal shaving is performed, and then bone cement is placed in the concave area above the brow bone, creating a smooth forehead.

However, this technique can create an over-projected forehead that does not fit the feminine ideal. It is important that a Type II brow bossing is only performed when the patient’s anatomy fits the procedure, and when it will not lead to over-projection.

Type III

A Type III brow reduction—sometimes called a forehead reconstruction—involves removing the bone above the frontal sinus. The bone is then reshaped and replaced. Occasionally, a small amount of bone cement is used to create the ideal shape. This makes the forehead smaller, less projected, and more feminine.

Type IV

Occasionally, the forehead will include both convex and concave features that need to be addressed. In this case, Dr. Sajan may perform a forehead reconstruction and then place bone cement in hollows to create a smooth, feminine curve to the forehead. This involves more extensive use of bone cement than in Type III.

During a consultation, Dr. Sajan will examine the exact shape of your forehead to determine the right surgical technique. The CT scan taken before surgery may also influence the technique because the thickness of the bone, position/size of the frontal sinus, and overall shape of the forehead can all contribute to the choice Dr. Sajan makes concerning your brow bone reduction.

Does A Brow Bone Reduction Leave Scars?

Regardless of the technique used, Dr. Sajan will likely need to make an incision on the scalp. Usually, this is made behind the hairline, though occasionally, it may be just in front. This allows him to better see and access the bone without placing any incisions on your face.

For most patients, their hair will naturally grow over and hide this scar. Visible scarring is still possible, and this is something you should consider before undergoing a brow bone reduction surgery.

Is It Painful?

Patients undergoing a brow bone reduction are placed under general anesthesia. Therefore, they do not feel any pain during the procedure. Like with all major surgeries, there is some associated postoperative pain. This is typically well managed with prescription pain medications.

How Do Male & Female Brow Bones Differ?

The male and female brow structures have some subtle differences that either masculinize or feminize the face. In general, a male brow is going to be longer and bigger, and the brow bone itself has more projection. This creates a noticeable protrusion towards the bottom of the forehead, near where it meets the nose.

A female brow has a more curved appearance that slopes downward towards the nose. This is a softer contour and appearance without major deviations in the shape of the forehead.

Are The Results Of A Brow Bossing Reduction Permanent?

Yes, bone cannot grow back when removed. Other aspects of the procedure may change with time, but it is unlikely you will see a major difference in the overall structure of the brows and forehead once enhanced by a brow bossing procedure. In contrast, a brow lift, which is often performed alongside a brow bone reduction, is not permanent.

Patients can, of course, sustain injuries that could damage their results or undergo other procedures that could change their results. This is rare and often correctable with surgery.

When Can I Wash & Dye My Hair Again?

Patients can wash their hair carefully after two to three days. However, you will want to do your best to avoid the incision area. After one to two weeks, you can typically begin washing your hair as normal.

As far as dyeing your hair, you will likely want to wait several weeks or even months before doing so. You will want to make sure that your incision is completely healed and that side effects have subsided. If you are wanting to dye your hair, it is usually recommended to do so before surgery. Otherwise, ask Dr. Sajan for a timeline of when you could resume dying your hair.

Dr. Javad Sajan is one of the top plastic surgeons offering gender-affirming surgery. Patients come from all over the United States and the world for his surgical skills and expertise. He has performed hundreds of gender-affirming surgeries with varying techniques, including many facial surgeries. Along with brow bone reduction surgery, Dr. Sajan also routinely performs FTM top surgery, tracheal shave, facial feminization, and MTF hair transplant.

Allure Esthetic makes the experience of seeking any gender-affirming procedure a seamless experience from start to finish. Dr. Sajan and the team have worked extensively with the transgender and LGBTQIA community to create a safe and affirming environment. This includes asking and using your preferred pronouns and name at all times. The Allure Esthetic team aims to maintain a warm and welcoming environment for patients of all identities.

To schedule a consultation with Dr. Sajan at Allure Esthetic, call us at 206-209-0988. You can also reach out via chat, contact form, or Price Simulator.