The need to change the shape of the forehead or brow bone is very rare. It is possible to reshape the forehead or brow bone (the bone below the eyebrows), but there are different procedures that can be done depending on the shape of the forehead and brow bone.
The shape of the skull between a man and a woman is usually quite different. The male forehead often has fullness above the brow bone known as a supraorbital bulge or a supraorbital bulge with a flatter forehead over this area. The female forehead, by contrast, has a more convex or curved forehead shape and little or no significant supraorbital bulge. Such forehead shapes confer a masculine or feminine appearance.
The degree of brow enhancement and the shape of the forehead help determine what type of surgical recontouring should be performed. With the exception of one other important consideration… the frontal sinus. The frontal sinus, an air-filled bony cavity, lies just below the brow bone and its development will affect surgical options. For this reason, any brow/brow modification surgical endeavor should have a plain skull x-ray (side view) prior to surgery.
In those patients with mild to moderate brow bump and thick skull bone over the frontal sinus (or missing a frontal sinus), bone reduction by reaming can be performed with good outcome. When there is brow bump but the thickness of the bone over the frontal sinus is thin, simple bone reduction contouring is impossible without entering the frontal sinus. Many attempt only a small bone reduction, without going into the sinus, but this does not make enough of a difference to justify the effort. Removing just 1 or 2mm of bone is not enough to make a difference. In this situation, one option is to open the frontal sinus, ream the edges of the bone, and reposition the ‘outer eyelid’ in a more inward contour, thus preserving the frontal sinus. The other option is to obliterate and fill the sinus with a bone substitute material, making a flatter brow contour with the bone paste or cement. (and not putting the outer bone board back in) I’ve done both and both will work. If I can get a nice brow contour and still leave the frontal sinus present and working, that’s my preferred option.
Any forehead and brow contouring requires an open approach through an incision in the scalp or hairline. The skin on the forehead must be ‘peeled back’ to have good access for surgery. An endoscopic approach or a more limited approach is not adequate to do a good job. In most women, hairline patterns and hair density make an open approach possible. When this procedure is considered in men, the hair problem makes an open scalp approach potentially more problematic.
In my experience, the most common patient for brow bone reduction is female feminization surgery (FFS), where the reduction of the prominence of the brow bone aids in the overall facial conversion from masculine to feminine appearance. In a select few men with very prominent brow bones, this procedure can make a big difference in softening the more ‘Neanderthal’ facial appearance.