Why frontal bone reduction is done

Frontal bone reduction is done as a gender affirming procedure for those seeking a more feminine appearance. This may help to reduce gender dysphoria symptoms, as well as improve overall quality of life for trans-identifying individuals.

Frontal bone reduction isn't for everyone. Your doctor might caution against surgery if you:

  • Have a significant history of sinus infections or facial trauma
  • Have a severe chronic condition, such as heart disease or diabetes
  • Have a body mass index that's greater than 35
  • Are a smoker

What to expect

  • Before the procedure you will have a consultation with your surgeon where you will come up with an individualized plan, as well as have a discussion of expectations. Pictures will be obtained from various views for planning as well as comparison following the procedure.
  • During the procedure you will be fully asleep (general anesthesia). Typically, incisions are made from ear to ear along the cranium. Meticulous dissection is carried down to the orbital rims. Augmentation or reduction is performed based on your individualized plan. If the frontal sinus is set-back, expect the bone to be replaced and held in place with plates and screws (titanium) that are usually permanent. The incisions will be closed with sutures and/or staples and drains may or may not be placed to help avoid blood collecting under the scalp tissues.
  • After the procedure it will be important to remain upright as much as possible to help reduce swelling and bruising. You will often be asked to avoid nose-blowing for a period of time to allow healing of the sinuses and prevent complications. You may be prescribed antibiotics and narcotic pain medication for comfort. Ice therapy will typically be recommended to help reduce swelling.
  • You may notice temporary hair-loss at the incision lines (telogen effluviam), however this typically resolves in several months.

Results

You can expect immediate improvement of the forehead contour following the procedure, however commonly swelling will soon set in and will take a period of time to resolve. Most swelling will be improved in 3-4 weeks, however, do not expect final results for about 1 year after surgery.

Risks of frontal bone reduction

  • Sinusitis/Mucocele. Manipulating the frontal sinus may lead to an infection. Blockage of the sinus outflow tract could lead to trapped mucus that can lead to secondary complications.
  • Intracranial injury. The frontal bone overlies the intracranial contents. While unexpected, inadvertent entry could lead to intracranial complications.
  • Failure to achieve desired result. Patients may not notice the improvement they were hoping. Counseling on realistic expectations is imperative prior to undergoing surgery.
  • Need for additional procedures. If any of the above are noted, it could mean additional procedures or surgeries would be performed for management.
  • Swelling/bruising. Significant swelling or bruising is likely to develop after the procedure. This may affect the eyes/eyelids and progress down the face and neck. Most swelling and bruising are expected to resolve within 3-4 weeks of the procedure.
  • Alopecia. Frequently the incisions are hidden within the hair. Hair follicles could be damaged or stressed during this process leading to hair loss that could be temporary or permanent.
  • Changes in skin sensation. During a frontal bone reduction, the elevation of tissues can affect the nerves in the scalp area. You'll likely feel some reduced sensation or numbness. This usually diminishes in the months after the procedure.

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