Facial Feminization Surgery - Forehead Burring or Fat Grafting?

Dear Sir or Madam, I am a 35 year old male-to-female transsexual who would like to undergo FFS. When I was doing my research in the internet I found there are obviously two ways to "flatten" the forehead: 1.) burring the brow ridge 2.) fat grafting Tbh, I am a bit confused. Method 1) is the procedure I already heard of which involves a large incision. The second option I was suggested from a plastic surgery clinic in South Korea. What would be the advantage/disadvantage on both methods?

Doctor Answers 3

Forehead feminization.

The male forehead differs from the female forehead because of a prominent ridge of bone above the eye sockets and a less vertical and more posterior oblique angulation of the frontal bone above this ridge. In feminizing such a forehead, the prominent brow bone needs to be reduced by burring it down with an electric drill. Since this bone sits in front of the frontal sinuses, in rare instances the anterior wall of the sinus has to be set back as well. In correcting the angulation of the posteriorly sloping forehead, I like to build it up with a synthetic, permanent material called methyl methacrylate rather than injecting with fat. I say this because you have to elevate the forehead skin to approach the brow bone to be reduced and this lends itself to placement of the methyl methacrylate. Fat wouldn't be stabilized or even persist with this open approach. If you had a very small brow bone that didn't need reduction, it's possible to inject the forehead with fat. But such injections may produce areas of irregularity, and the longevity of such placed fat is questionable.

Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 2 reviews

Facial feminization of the forehead in the TG patient.

Facial feminization  of the forehead in the TG patient is something I have done for 35 years. Burring the bone away gives accurate results and can be done thru a hairline scar. Fat grafting I use elsewhere but not on the forehead where it can move and give asymmetry and makes the forehead larger not smaller which burring does. 

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 32 reviews

Forehead contouring

I agree that fat grafting to the forehead is not the way to go for this because most of the times the fat would resorb due to the repeated muscle action in the forehead. As far as forehead contouring is concerned we go through a fine incision hidden in the hairline, access the boe and then remove the redundant bone. This is not a simple "burring" though!  In the process we preserve a nice thick wall to the frontal sinus which is hidden in the frontal bone and set the wall back by preserving its thickness and strength - something that very few surgeons in the world do. After this we are able to lift the brows and advance the hairline to give it a more round-shaped feminine look. Thank you!

Vartan Mardirossian, MD
Jupiter Facial Plastic Surgeon
4.7 out of 5 stars 31 reviews

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