How Can I Feminizine My Masculine Forehead?

Q: Dr. Eppley, I’m most concerned about the thickness of the orbital rims. I’ve always felt my eyes looked sunken and I never really understood why, but now that I’ve been researching it seems to be that I have very thick orbital rims.

I feel the center area, at the glabella, is not nearly as prominent as the rest of the orbital rims.

I have had a minor upper blepharoplasty  probably 20 years ago.

And my eyebrows are tattooed.

I have not liked my hairline either and do feel it is pretty high and masculine looking as well.

The only thing I feel I couldn’t do is the type 3 forehead reduction. That just seems too much for me for cosmetics.

I also don’t love the idea of the full hairline incision, but do realize that may be necessary.

A:Thank you for sending your pictures. I can certainly appreciate your orbital rim prominence concerns. Whether they can be reduced by shaving or requires a bone flap setback depends upon which areas of the brow bones you feel need to be reduced. In the attached picture I have noted the two different areas of the brow bones, medial and lateral. Their bony composition is quite different with the medial being created by the aeration of the underlying frontal sinus and the lateral being created by solid bone. As a result the techniques needed to reduce them are different. Medial brow bone prominence reduction requires a bone flap setback while lateral brow bone  prominence reduction can be done by shaving. Well these techniques are different I don’t think to the patient it really makes much difference in terms of the surgical recovery but it could make a big difference in the aesthetic outcome depending upon the brow bone areas that need to be reduced.

With either brow bone reduction technique this does require superior incisional access which in the high frontal hairline would be done through a hairline approach. Given that you already have concerns about a high hairline this does provide the opportunity to do some frontal hairline advancement at the same time. Without a frontal hairline incision this would require a full bicoronal scalp incision placed way behind the hairline from ear to ear.

In addition to the brow bone reduction there probably is also some benefit of upper forehead reduction as well in the spirit of an overall forehead feminization effect.

Dr. Barry Eppley

Plastic Surgeon