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Q&A WITH DR. ALEX FACQUE: Brow Bone Reduction and Hairline Advancement: What are the options? BROW BONE REDUCTION The bony structure of the forehead, often called the “brow bone” and “brow,” is made of the frontal bone and gets its appearance from the size and shape of the frontal sinus and soft tissues of the brow. During a testosterone puberty, the frontal sinus enlarges and creates prominence just above the eyes in the middle of the forehead. Some patients experience dysphoria related to a protrusive brow bone. In certain individuals, the front wall of the frontal sinus can be removed and then secured back in place so that the forehead appears flatter. In medical terms, this is called a “setback,” alluding to the procedure name “frontal sinus setback.” In a small number of people, about 4-5% of the population, the front wall of the frontal sinus is thick enough that it can be shaped to achieve the desired effect without being removed. This is called “frontal bone contouring.” Before surgery, your surgeon will order a CT scan of the patient’s facial bones to help determine which type of surgery is needed for any given individual. Our surgeons often combine this procedure with reshaping the orbital bones (the bones of the eye socket) to help feminize the eye shape. This can help make the eyes appear more open and rounded, which is more typical of the eye shape created during an estrogen-influenced puberty. Reshaping the orbital bones also allows for greater lifting of the brows for patients who want that done as well. HAIRLINE “CORONAL” INCISION Typically, in order to contour the brow bone and perform a frontal sinus setback, a “coronal” incision is made. This refers to an incision that goes up and over the head on the scalp, following the hairline. The coronal incision allows the surgeon to perform the frontal sinus setback (brow bone contouring), brow lift, and hairline advancement/reshaping. If the patient would also like to decrease the length of the forehead (a procedure called scalp advancement/hairline lowering), the incision is made just in front of the existing hairline, called a “pretrichial coronal incision”. Only by placing the scar there is your surgeon able to make the forehead shorter and also change the shape of the hairline. It is important to understand that while this scar typically heals very well, it will be visible at conversational distances. Some patients choose to cover the scar with makeup or with hair pieces if they choose. For some patients with hair loss, this is a good option to feminize the hairline and remove areas of hair loss at the temples (also called temporal alopecia). For some patients, other procedures such as hair transplants may also be necessary in order to fully achieve the desired result. If a patient does not want to have a visible scar along their hairline or does not want to have changes made to their hairline or forehead length, they can decide to move the incision back a couple of centimeters where it will be hidden within the hair. Unfortunately with this option, hairline advancement or reshaping won’t be possible. GENDER AFFIRMING HAIRLINE SURGERY Many of our patients who seek GAFS report experiencing dysphoria related to their hairline. One of the most seen effects of testosterone on the body is the recession of the hairline, giving it an “M”-shape. The purpose of the hairline advancement technique is to round out the corners of the “M,” which can help create a smaller, more rounded out forehead or conventionally feminine face. Our surgeons use the same coronal incision as the frontal sinus setback to lower and/or reshape the hairline. “Hairline reshaping” is another variation of this procedure that is more commonly performed on younger patients who have not started to experience hair loss. Older patients typically request both hairline lowering and reshaping, which can be difficult to achieve. Given the limitations of a patient’s scalp, and when given the choice, the vast majority of patients focus on reshaping their hairline rather than lowering. Once healed, this technique can be combined with hair transplants to help create a fuller hairline. _______ For more educational resources about gender-affirming facial surgeries: https://www.genderconfirmation.com/ff... To book a consultation with Dr. Facque: genderconfirmation.com/consultation-request/ Please visit our website: genderconfirmation.com ⠀ #DrFacque #DrLey #DrMosser #GenderConfirmationCenter #trans #transgender #transisbeautiful #sanfrancisco #AllGender #GenderAffirmingCare #TransCare #transproud #Transpride #transgendersurgery #nonbinary #nonbinarysurgery #ffs #fms #facialsurgery #facialfeminization #facialmasculinization #gcfs #gafs