The forehead is one of several facial features that can appear more masculine or feminine depending on the shape and size. The shape of the forehead is one of the key differences between males and females. For example, masculine foreheads usually have a dense, bony ridge, known as “brow bossing” whereas feminine foreheads are smoother and less ridged. In some ethnic group, females may have masculine foreheads, and likewise, males may present with feminine foreheads.

Characteristics of Female Forehead
Characteristics of Female Forehead

Forehead contouring and reduction is a surgical procedure used to reduce the appearance of a prominent or masculine forehead. This procedure reduces these prominent ridges and reshapes the brow bossing, creating a softer, more feminine appearance. It is also performed on women who feel their brow and forehead appear too prominent or masculine. Forehead contouring and reduction surgery focus on three primary areas to achieve a more feminine appearance, namely:

  • Brow bossing
  • The slope of the forehead
  • The flat spot

To access the forehead area, an incision is made either right at or behind the hairline, depending on whether or not the hairline position needs to be changed. Although the exact procedure depends on the individual patient, most often the brow ridge (brow bossing) is osteotomized and reconstructed to reduce the appearance, and the orbital bones are shaped to minimise masculine characteristics.

Typically, the frontal bone (between the eyebrows) is removed, shaped, and then reattached so that it does not interfere with the underlying sinuses. If the forehead must be reshaped, to fill in a ridge or concavity, a synthetic material (synthetic bone graft) or alloplastic implant (forehead implant) can be used to create the desired more rounded shape. Occasionally, fat grafting can be used to create a more natural rounded appearance of the forehead. Due to the location of the incision, forehead contouring is often done in conjunction with blepharoplasty, brow lift or hairline restoration.

Ideal candidates for a forehead contouring surgery:

  • Having a positive outlook, realistic expectations and specific goals in mind for the improvement of facial appearance.
  • Physically healthy with no active or severe pre-existing medical conditions
  • A patient who has a prominent or masculine forehead
  • A patient who desires for a rounded and feminine forehead

Preoperative evaluations and preparation for a forehead contouring surgery include:

  • Discussion about patients’ expectations and desired outcome
  • Blood investigations or a medical examination for fitness of anaesthesia and surgery
  • Evaluation of medical conditions, drug allergies and previous medical or surgical treatment
  • Avoid certain medications or adjust your current medications
  • Avoid taking aspirin or certain anti-inflammatory drugs or herbal supplements that may increase bleeding
  • Stop smoking or alcohol well in advance (2-3 weeks before surgery)
  • Examination of the face and its soft tissues
  • Radiological assessment (CT scan of a face)
  • Preoperative evaluation for general anaesthesia
  • Photography for preoperative and postoperative evaluation

The risks and safety information on forehead contouring surgery

It is essential for patients to understand that every surgical procedure has its complications and risks involved. However, if a patient is adequately assessed before the surgery and postoperative care is given sufficiently, these risks can be eliminated or reduced. The risks involved in forehead contouring surgery are:

  • Bleeding
  • Blood clot
  • Infection
  • Bruises and swelling around the forehead and eyes
  • Injury to the surrounding nerves, blood vessels, muscles or bones
  • Changes in the skin sensation over the forehead and scalp
  • Loss of hair at the scalp
  • Itchiness at the scalp
  • Visible scars at the scalp
  • Bony contour irregularity
  • Asymmetry
  • Anaesthesia risks
  • Possibility of revision surgery

Postoperative expectations

During the initial healing phase, the patient may experience pain, numbness, bruises and swelling around the forehead and periorbital areas. These symptoms are transient; usually, last about 3-4 weeks. The sutures on the scalp areas are usually removed about 7-10 days after the surgery. Oral antibiotics and analgesics will be prescribed to reduce the risk of infection and postoperative pain respectively.

Postoperative care

  • Follow the postoperative instructions given carefully
  • Head elevation especially when sleeping for 3-4 weeks
  • Take the prescribed medications as instructed
  • Compressive dressing around forehead for 5-7 days
  • Wound care for any external wounds
  • Regular hair wash if necessary or permitted
  • Avoid strenuous physical activities for 3-4 weeks

How much will a forehead contouring surgery cost?

Cost is always a consideration in elective surgery. The cost of contouring surgery can vary widely. Cost may include:

  • Surgeon’s fee
  • Hospital or surgical facility costs
  • Medical tests (blood and radiological investigations)
  • Cost of plates and screws
  • Anaesthesia fees
  • Prescriptions for medication

Forehead contouring surgery is a cosmetic surgical procedure. Therefore, most of the health insurance companies do not cover cosmetic surgeries or their complications.