Is Brow Bone Reduction Surgery for Feminization painful?
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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.
Brow Bone Reduction Surgery | Gender Affirming Brow Bossing
A brow lift is frequently part of facial feminization surgery because it lifts the eyebrows into a higher, more feminine position. However, this only addresses the skin and underlying tissues. Occasionally, to obtain a fully feminized look, patients may need to treat the bone as well. A brow bone reduction helps create a softer forehead contour that better resembles the look of a woman’s. Acclaimed gender surgeon, Dr. Javad Sajan,
What Is A Brow Bossing Reduction?
Brow bossing reduction refers to a surgical proceduire to reduce the protrusion of the brow bone. Located between the eyebrows, the brow bone is larger and creates a noticeable ridge or hump between the eyebrows. In people assigned female at birth, the brow bone does not usually protrude. Instead, there is a soft curve from the hairline to the nose.
The procedure is most associated with transgender women who have a prominent brow bone and want a more feminine appearance. However, people of all gender identities seek the procedure. Dr. Sajan frequently performs a brow bone reduction during facial feminization surgery.
Benefits For Transgender Patients
While not all people assigned male at birth will have prominent brow bone, male and female skulls can often be distinguished based on the flat space between the eye sockets and protrusion of the brow bone. Thus, many transgender women choose to undergo a brow bone reduction in pursuit of forehead feminization.
Some of the benefits of this include:
Less prominent brow bone
More feminine forehead contour
Likely will address prominence of the orbital bones at the same time
Makes passing as their preferred gender easier
Helps reduce gender dysphoria
Easy to combine with other gender affirming surgeries such as hairline lowering and a brow lift
Personalized to match the patient’s facial features and goals
Recovery similar to facial plastic surgeries
Performed by an experienced plastic surgeon with fellowship training in FFS
Types Of Brow Bone Reduction
There are four main types of surgical brow bone reduction. Though, two are rarely performed for transgender patients. To determine the right option for every patient, Dr. Sajan’s facial feminization and brow bone reduction patients undergo a CT scan before surgery. This helps him determine bone thickness, the size of the frontal sinus, and other details of the anatomy that impact the correct surgical technique.
The types of brow bone reduction are:
A type I brow reduction involves burring, or shaving, down the bone. To qualify for this method, a patient must have a thick anterior wall covering the frontal sinus. This means that the bone can be shaved down at least 5 millimeters. This will only occur for about five percent of all patients. Additionally, it is not always possible to reduce a male brow bone to female contours by only burring down the bone.
A type II brow reduction has a small candidate pool. It involves shaving down the bone and then using bone cement to fill in the resulting space. The type II technique should only be used when the angle between the forehead and nose is within the feminine ideal already.
The most performed and arguably most effective brow bone reduction method for transgender patients is Type III. During this procedure, Dr. Sajan removes the frontal sinus bone and shaped before placing it back over the frontal sinus. Occasionally, the frontal sinus itself is reshaped, to accommodate the new forehead contour. This step is not necessary for all patients.
This brow bone reduction technique usually refers to a Type III brow bossing reduction where bone cement is also used to achieve the ideal contour. Compared to Type III, this is less common.
Beyond the way Dr. Sajan reduces the brow bone, the surgical procedures are otherwise quite similar. Types III and IV use titanium microscrews. These extremely small screws generally go unnoticed by metal detectors and airport security. The heads of the screws are also removed so that they are not visible through the skin.
Is The Scar Visible?
It depends. If performed by itself, Dr. Sajan will likely use a coronal incision which is hidden far back into the hair. Thus, it is not visible. However, when performed with other procedures such as hairline lowering or a brow lift, Dr. Sajan will utilize the same incision.
In the case of hairline lowering, the scar may be visible for a time. Throughout the healing process, it usually blends in with the new hairline. These incisions do have a higher risk of being visible once healed. Still, this is a fairly low risk and often worth it for many patients. A hair transplant can help hide hairline scars.
What Is A Brow Bossing Reduction Recovery Like?
Recovering from a brow bone reduction surgery can vary because it is often performed alongside several other procedures during facial feminization surgery. In general, patients may feel some manageable discomfort and experience swelling near and around the eyes. Bruising is also common. Patients are usually given instructions such as:
Keep head elevated to reduce swelling
Protect surgical area from sun exposure
Avoid strenuous activities
Attend post-operative appointments
Do not remove any wraps or garments unless instructed by Dr. Sajan
Follow Dr. Sajan’s incision/scar care instructions
Is A Brow Bone Reduction Permanent?
Yes, while it is possible that the skin and soft tissues may shift with age, the bone itself will remain smaller and less prominent.
Are There Any Risks To The Sinuses?
With a type III brow bossing reduction, it is understandable that patients may have concerns about the frontal sinus. When this technique is used, there are some added risks to the sinuses. However, these are rare. Firstly, Dr. Sajan orders CT scans because this allows him to know exactly where the frontal sinuses are and the thickness of the skull. This prevents many possible complications.
The primary risk to the sinuses is infection. This rarely happens, but if it does, it usually responds well to treatment and does not cause major problems for patients. Dr. Sajan’s preparations help protect the frontal sinus and make the procedure as minimally invasive as possible.
Who Are Candidates For A Transgender Brow Bossing Procedure?
Candidates for a transgender brow bone reduction tend to have qualities such as:
A prominent brow bone/forehead
Documented history of gender dysphoria
No major injuries or surgeries to the brow bone/orbital bones
Managing any significant medical conditions
Has a history of healing well from past surgeries, procedures, and/or injuries
Understands the procedure and has realistic expectations
Brow Bone Reduction By Dr. Javad Sajan
Dr. Javad Sajan is a world renowned plastic surgeon who specializes in gender affirming surgeries. His patients come from around the globe for his expertise and dedication to serving the trans community. Dr. Sajan customizes every procedure to fit the patient’s anatomy and goals. Alongside transgender surgery, he performs traditional plastic and reconstructive surgery. Dr. Sajan understands the intricacies of transgender surgery.
To learn more and schedule a consultation, call us at 206-209-0988. Patients can also reach out online via chat, contact form, and Price Simulator.