Brow bone reduction is typically performed under general anesthesia on an outpatient basis, so you’ll go home a few hours after the surgery. You’ll be groggy from the anesthesia, so plan to have someone take you home safely and stay with you for at least the first 24 hours after surgery.Â
The procedure can be accomplished through a variety of techniques, and your surgeon may use one of two types of incisions are used to reach the brow bone: one at the hairline (known as a trichophytic incision), or one that spans from ear to ear over the top of the scalp (aka a coronal incision).
The position of the incision will be determined by your forehead anatomy, hairline, and whether or not you’re having complementary plastic surgery procedures at the same time.
Hair loss is an important consideration with the incision placement. “For women or trans women on hormone therapy, it’s rare to have a significant hairline recession,” says Dr. Rolfes. “However, since most men will have at least a little hair loss with time, you can’t make the incision for a man in the same place as you would for a woman, or you risk having it be very visible in 10 or 20 years.”Â
A hairline incision is more visible initially, but it allows the surgeon to advance the hairline, a plus if one of the patient’s goals is to lower the hairline. “The incision is angled, so hairs grow through it and camouflage the incision,” says Dr. Rolfes.Â
Once the incision is made, the brow ridge can be reduced.
- If the bone is dense or has minimal “brow bossing,” it can be simply shaved or burred down (a technique known as a type 1 cranioplasty).
- If the bone is thin, or significant brow reduction is desired, the bone must be removed, reshaped (possibly with bone cement, to create the contour and help reduce the risk of bone erosion over time), and secured back into place with tiny titanium screws (a type 3 cranioplasty).Â
To create your desired result, the lateral orbital rims (the bones around the outside of the eyes) may need to be reduced as well. These bones are very thick, so they can usually be reduced significantly with shaving or burring. Reducing the orbital rims helps open up the eyes and allows light from above to illuminate them—making them appear brighter, softer, younger, and more feminine.