What does it change?
The shape and projection of the forehead and brow bone.
It changes bone contours, rather than only lifting the eyebrows or smoothing skin.
Gender-affirming facial surgery
Feminizing Forehead Contouring / Frontal Bone Reduction
Feminizing forehead contouring reshapes the forehead and brow bone to create a softer profile that better aligns with your gender goals.
Does everyone need the same technique?
No. Bone thickness and frontal sinus anatomy help determine the approach.
Some areas can be reduced by burring; a projecting brow over a frontal sinus may require repositioning the sinus's front wall.
Is this the same as a brow lift?
No. A brow lift moves soft tissue, while forehead contouring reshapes bone.
The procedures may be combined, but each addresses a different concern.
01 · Overview
Understanding forehead and brow bone contouring
Feminizing forehead contouring, sometimes called frontal bone reduction, reduces prominent bone above the eyes and reshapes the forehead. It may be one part of facial feminization surgery or a procedure considered on its own. There is no single forehead shape that defines femininity. [1]
The frontal sinuses are air-filled spaces behind part of the brow bone. Their size and the thickness of the bone in front of them limit how much can safely be shaved down. Planning often includes CT imaging to help the surgeon choose between burring and repositioning the front wall of the sinus. [1]
A brow lift changes eyebrow position, and hairline advancement shortens the visible forehead by moving the scalp forward. Neither is the same as bone reduction, although they can sometimes be performed together. A consultation should separate these goals and explain what each procedure can and cannot change. [2]
- Treatment area
- Forehead and brow ridge
- Anesthesia
- Usually general anesthesia
- Main approaches
- Bone burring or frontal sinus wall setback
- Planning
- Examination and often CT imaging
What is a frontal sinus setback?
The surgeon removes a planned section of the front wall of the frontal sinus, reshapes it, and secures it in a less projecting position, often with small plates and screws. This is more involved than shaving the bone and requires careful protection of the sinus and nearby structures.
Can I choose the amount of reduction?
You can describe the profile and degree of change you prefer. The safe amount of reduction depends on your bone, sinus anatomy, eye socket contours, and overall facial proportions. Reference images can help communication, but cannot predict your result.
02 · Concerns & Goals
What you may want to address
You may notice a prominent brow ridge or feel that your forehead profile does not reflect you. Your goals guide the conversation.
A prominent brow ridge
Bone above the eyes may cast shadows or create a projection you would like to soften.
Forehead profile
You may want a smoother transition between the upper forehead, brow, and bridge of the nose.
Uneven contours
Differences between the two sides may be noticeable. Surgery may improve balance, but perfect symmetry is not realistic.
Forehead height or eyebrow position
A high hairline or low brow may contribute to your concerns, but these usually require a separate soft-tissue procedure rather than bone reduction alone.
03 · Options
How the approaches differ
These approaches are not interchangeable. Your surgeon may combine them based on your anatomy and the changes you want.
Bone burring
Reduces selected areas of prominent bone.
How it worksA surgical burr gradually reshapes bone while preserving a safe thickness.
May suitPeople whose bone thickness and sinus anatomy allow the planned reduction without moving the sinus wall.
Main tradeoffThe amount of reduction is limited; burring alone may not adequately reduce a prominent brow over the sinus.
Frontal sinus wall setback
Moves the projecting front wall of the frontal sinus backward.
How it worksThe surgeon reshapes and repositions a bone segment, then secures it in place.
May suitPeople whose brow projection cannot be adequately or safely treated with burring alone.
Main tradeoffIt adds bone-healing, fixation, and sinus-related considerations.
Targeted brow rim contouring
Refines selected edges of the bone above and around the eyes.
How it worksThe surgeon carefully reduces appropriate areas of the upper or outer eye socket rim, often alongside central forehead work.
May suitPeople with localized prominence that contributes to a heavy brow appearance.
Main tradeoffNearby nerves and eye structures limit what can safely be changed.
Combined forehead, brow, or hairline surgery
Addresses bone shape together with selected soft-tissue concerns.
How it worksBone contouring is paired with a brow lift, hairline advancement, or both when appropriate.
May suitPeople who want changes in eyebrow position or visible forehead height as well as bone projection.
Main tradeoffAdditional procedures can change scar placement, recovery needs, and the risk of scalp numbness or hair loss.
The surgical plan should explain which changes involve bone and which involve the brow or scalp. Not every person needs sinus wall repositioning or additional procedures. [1] [2].
Where will the incision be?
Access is commonly through an incision at the hairline or farther back within the scalp. Hairline goals, hair density, previous surgery, and the amount of exposure needed influence placement. Ask where the scar will sit and how future hair thinning could affect its visibility.
Will plates or screws need to come out?
Fixation hardware used for a setback is often intended to stay in place. Removal may be considered if it causes symptoms or a complication. Ask your surgeon what hardware is planned and what follow-up it requires.
04 · Results
What may improve and what may remain
Changes in profile
The aim is a less prominent brow and a smoother forehead transition.
- The achievable change depends on bone thickness, sinus anatomy, and surrounding facial features.
- Bone contouring does not by itself lower the hairline or reliably lift the eyebrows.
A result that develops gradually
Early swelling can hide the new contours.
- Bruising and swelling generally improve before all firmness or altered sensation settles.
- Your surgeon will assess contour, scars, and healing over several months.
Long-term considerations
Bone changes are intended to be lasting, but appearance continues to change with aging.
- Scars, hair changes, asymmetry, or contour irregularities may remain.
- Some people consider revision, which requires a new assessment of healing, anatomy, and risks.
Facial feminization surgery is individualized. It cannot guarantee a particular appearance, relief of dysphoria, or how other people perceive your gender. [1]
05 · Recovery
Planning your recovery
Recovery at a glance
- Stay after surgery
- Determined by Your Surgeon
- Initial recovery at home
- Varies by Individual
- Return to desk work
- Varies by Procedure and Work Activity
- Light daily activities
- Based on Individual Recovery
- Strenuous exercise
- Based on Surgeon Clearance
Returning to work does not mean fully healed. Follow your surgeon’s instructions; strenuous activity requires clearance.
Recovery depends on whether you have burring, sinus wall setback, or combined procedures. Your surgical team's instructions take priority; returning to routine activities does not mean the bone and soft tissues have fully healed.
Step 1 · Day of surgery
Treatment day
After anesthesia, the team monitors your comfort, swelling, and readiness for discharge or an overnight stay. Arrange an adult escort and the help your team recommends.
Step 2 · First several days
Early recovery
Forehead and eyelid swelling, bruising, tightness, and scalp numbness may occur. Follow your personal wound-care and medication plan. Ask your surgical team whether compresses are appropriate and exactly how to use them.
Step 3 · Following weeks
Returning to routines
Light routines may become easier as swelling and fatigue improve. Work, lifting, exercise, and any sinus precautions need separate guidance based on the operation you had.
Step 4 · Following months
Continued healing
Scars and swelling continue to settle, and sensation may change gradually. Keep follow-up visits so the surgeon can check bone healing, contour, and any sinus or hardware symptoms.
Planning everyday activities
ActivityGeneral planning contextWhat affects the plan
Desk workPlanning context: Some people plan around two or more weeks away, with longer leave for combined procedures or a demanding recovery. [1]What affects it: Fatigue, swelling, discomfort, and public-facing duties can delay a comfortable return.
DrivingPlanning context: Resume only when your team agrees and you can drive safely without sedating medication.What affects it: Eyelid swelling, vision, alertness, and the ability to react comfortably matter.
Exercise and liftingPlanning context: Ask for a staged return rather than using the return-to-work date as clearance.What affects it: Straining, swelling, and protection of healing bone may require longer restrictions.
Contact sportsPlanning context: Wait for explicit clearance before activities that could strike the forehead.What affects it: Bone healing and any fixation hardware require protection beyond early skin healing.
If your frontal sinus is involved, ask specifically about nose blowing, sneezing, flying, and diving. Restrictions depend on your operation and healing.
Before your procedure
- Describe the forehead and brow changes you want, including changes you do not want.
- Share prior facial surgery, sinus problems, injuries, and any available imaging.
- Review all medicines, hormones, supplements, and allergies; do not stop prescribed treatment on your own.
- Discuss nicotine use and the surgeon's requirements for stopping before and after surgery.
- Arrange transportation, home support, and time away from work that fits the planned scope.
- Get written guidance on fasting, incision care, follow-up, and whom to contact after hours.
Is numbness expected?
Temporary numbness or altered sensation of the forehead and scalp can occur after the incision and tissue dissection. Improvement may take months, and some changes can persist. Tell your team about painful, worsening, or unexpected symptoms.
What if I am traveling for surgery?
Discuss travel before booking. Ask how long to stay nearby, when the first follow-up occurs, whether flying needs to be delayed, and who can assess complications once you are home.
06 · Safety
Risks and what your clinician assesses
Swelling, bruising around the forehead or eyes, tightness, tenderness, and temporary scalp numbness can occur. These should generally improve; new or worsening symptoms deserve advice from your surgical team.
Bleeding and infection
Bleeding, a collection of blood, or infection may require medication, drainage, or another operation.
Scars and hair changes
Scars may widen or remain visible. Hair thinning or loss can occur along the incision and may be lasting.
Nerve injury
Numbness, pain, or altered sensation may persist. Injury to nerves affecting brow movement can cause weakness or asymmetry.
Contour or bone-healing problems
Unevenness, undercorrection, overcorrection, bone-healing problems, or bothersome hardware may require further treatment.
Sinus and nearby structure injury
Sinus surgery can lead to drainage problems, infection, or a delayed mucus-filled cyst. Rare serious injuries can involve the eyes or the lining around the brain, including a cerebrospinal fluid leak.
Anesthesia and blood clots
Anesthesia reactions, breathing problems, and blood clots are possible with surgery. Your health and the length of the operation affect these risks.
Discuss these risks and your individual health history with your surgeon. [1]
What your clinician assesses
- Forehead shape, bone thickness, frontal sinus anatomy, and asymmetry
- Hairline, scalp health, eyebrow position, and prior facial procedures
- Medical conditions, medications, nicotine use, and anesthesia or clotting history
- Personal goals, expectations, emotional readiness, and recovery support
07 · Costs
What makes up the Total Procedure & Care Cost
Compare written estimates for the same planned scope: burring alone, frontal sinus setback, and combined brow or hairline surgery can involve different services. Ask whether insurance authorization or coverage requirements apply to your plan.
Surgeon
Surgical care
The surgeon's work for the specific bone contouring and any agreed additional procedures.
Ask your surgeonAsk whether consultations, CT planning, fixation hardware, and possible revision care are included or billed separately.
Facility
Anesthesia and facility
Anesthesia services, operating-room use, and recovery monitoring.
Ask your surgeonAsk about separate provider bills, overnight care, and charges if more time or care is needed.
Supplies
Supplies and follow-up
Items such as dressings, prescriptions, and postoperative visits.
Ask your surgeonConfirm which supplies and visits are included and how unexpected treatment is billed.
TRC
Patient Services
Any separately offered scheduling, navigation, or care-coordination support.
Ask TRCAsk whether these services carry a fee, what they include, and whether travel or lodging is separate.
Your written estimate should explain the services included, any separate charges, and payment terms.
08 · Questions
Common questions
Do I need hormone therapy first?
Hormone therapy does not substantially reduce an established bony brow ridge. Requirements for surgery or insurance coverage vary; discuss your goals and any documentation requirements with the surgeon and insurer.
Will this change my entire face?
It changes the forehead and brow framework, which can influence overall facial balance. It does not directly reshape the jaw, nose, or other facial areas.
Can it be combined with other facial feminization procedures?
Sometimes. Combining procedures may reduce separate recovery periods but can mean a longer operation and more demanding recovery. Staging procedures may be preferable for some people.
How do I choose a surgeon?
Look for appropriate board certification, relevant hospital privileges, and specific experience in forehead bone contouring and frontal sinus setback. Ask how the surgeon plans imaging, protects sinus function, and manages complications.
0 consultation questions in your plan
View in My TRC workspaceMy Aesthetic Plan
Prepare for your consultation
Bring these to help your consultation:
- Confirm the bone procedure and any separate brow or hairline procedures.
- Review risks, recovery support, activity restrictions, and follow-up arrangements.
- Obtain a written estimate and clarify coverage and separate charges.
View My Aesthetic Plan
Choices stay in this visit until saving to your account completes. Nothing is sent to a clinician.
Sources
- [1]Mayo Clinic — Feminizing surgeryFacial feminization goals; forehead bone reshaping and sinus considerations; individualized planning; surgical risks, recovery, and follow-up.
- [2]American Society of Plastic Surgeons — Facial Feminization SurgeryDifferences among forehead reduction, brow lifting, and hairline procedures; combining procedures to address individual facial feminization goals.
Photographs are illustrative scenes, not patients, staff, facilities or outcomes. This information does not replace a personal assessment by your treating clinician.