Forehead surgery (Cranioplasty) is a key procedure in FGCS as there are often significant differences between male and female brows. Males often have a horizontal bone ridge above the eyebrow which extends to the supraorbital rims.
To address this problem a coronal incision is made in the scalp which is concealed in the natural body and folds of the hair. The position of the incision is variable and can depend upon hair density when immediate hair transplants are to follow. The incision runs from ear to ear, the scalp is detached and moved forwards which enables access to the forehead.
During the procedure the brow ridge is ground down and the entire forehead is smoothly rounded. Between the eyebrows the Glabella covers the frontal sinus, as the area underneath is hollow, then it is often too thin to grind down. In most cases the Glabella is removed and then remodelled and re-fixed into the new feminine position.
If frontal brow bossing is not present, but supraorbital bone is apparent. A specialised technique is adopted where access to the bone is gained through an incision above the eyelid (As with an upper blepharoplasty) The supraorbital ridge is then ground down and the incision is concealed within the natural fold of the eyelid.
The results of forehead reconstruction are often profound and completely change the appearance of the forehead from male to female. Many patients have a fringe to conceal their forehead, but after remodelling the hair is tied back to reveal a positive female gender characteristic.