Forehead Feminization Surgery FAQ

As with all gender-affirming surgeries, whether you should get Forehead Feminization Surgery is a deeply personal decision. How your facial bones respond to testosterone exposure is unique to you, and there is no single measurement that dictates whether or not your forehead should cause or not cause dysphoric feelings.

We know that exposure to testosterone during puberty in folks assigned male at birth causes the brow area to thicken, and the eye sockets to become slightly hooded or less rounded.

There is also overall forward growth of the bones that make up the forehead region, including increased thickness of the bones to the sides of the forehead. From research done during the COVID-19 pandemic when coverage of the lower two-thirds of the face was required, we also know that the forehead region plays an important role in gender recognition.

You can consider forehead feminizing surgery if you feel like your forehead is a major source of dysphoria or causes you to be misgendered.

At Catalyst Surgical, we use the ForeContour method developed by Facialteam.

This method falls within the “type III” category for forehead feminization. We use a 3D reconstruction derived from a CT scan of your face and skull to plan our approach.

The incision we use is hidden within your hairline, behind the crown of your head, which is a variation of the traditional “bi-coronal incision”.

From there, we access your entire forehead and the tops of your eye sockets. We are careful to avoid damaging the nerve that gives feeling to your forehead (also called the trigeminal nerve, and more specifically, the supraorbital branch). If necessary, we use an ultrasonic saw to free your nerve from its bony canal in order to protect it.

We make precise cuts to the front of your forehead over your frontal sinus to remove the front wall (or anterior wall) of your frontal sinus. This is to avoid shaving through it or shaving it down too thinly.

The forehead bones are then shaved with high-speed burs to create a smoother, rounder forehead in alignment with your existing skull curvatures to reduce the bony growth you experienced from testosterone exposure in puberty.

The anterior wall that was removed is contoured to match the new forehead and brow contour. It is fixed in its new position with either two thin titanium plates and screws or a thin titanium mesh. We only use the mesh if we feel the anterior wall piece is fragile or has gaps.

We then shave the upper portion of your eye sockets with a different high-speed bur to undo the bony hooding formed due to testosterone exposure, making your eye sockets more round, even, and smooth.

After all of these steps, the eyebrows often settle in a higher position. Sometimes, we use a brow lift to reinforce this change. Both the reduction in forward projection of the brow bone and the higher position of the eyebrows result in a more feminine profile that applies across different ethnicities.

Immediately after surgery, you’ll stay with us for one night after surgery so that we can observe you. You will have a drain that stays in overnight and is removed the next morning. You’re allowed to eat after surgery. Depending on whether you’ve had any other surgeries, it may be difficult to eat normally.

On postoperative day 1, you’ll see our lymphatic drainage specialist to help you reduce the immediate swelling. We will then review your post-operative instructions with both you and your caregiver before sending you home.

We will see you again at the one-week mark for a second lymphatic drainage therapy session and to remove your sutures.

You can expect substantial swelling and bruising, though some people get away with very little. The majority of the bruising will diminish within a few weeks. In the meantime, your physical activity should not be more intense than brisk walks, as spikes in blood pressure with heavier activity can cause more swelling and set back your overall recovery. Around six to eight weeks after surgery, you can start ramping up your physical activity to higher intensities.

After the first week, we like to see our patients at the one, three, six, and 12-month marks. Sometimes more frequent visits are needed or wanted, and your follow-up schedule will be tailored to your specific needs.

It takes months for the swelling to truly get out of your face. Most of it will be resolved in 3 months, but you will still look puffier than the 1-year mark.

Forehead Feminization Surgery changes the bony framework of your forehead. How the overlying tissues react to the recontouring of your bones varies and the most significant changes happen within the first year. What you see at 3 months is not what you will see at 12 months.

The range of prices depends on the surgeon and patient characteristics. At Catalyst Surgical, Forehead Feminization Surgery starts at $24,590.

The following services are included in all of our quotes:

• Post-operative visits and nursing care
• Pre-operative consultation, standard pre-operative preparation
• Material costs
• Costs for the surgical facility and general anesthesia
• 1 night in our facility
• Lymphatic drainage therapy
• 24-hour post-surgical support