For patients with a large bony prominence at the brow, the bone can be reduced to create a more feminine look. This surgery is often combined with a browlift and hairline advancement. The browbone is the front wall of the frontal sinus. The frontal sinus is like a cave. When the front wall of the cave (the browbone) protrudes out too far, there are two main options to reduce it.
Type 1 Browbone Reduction
The first is commonly referred to as a “Type 1 Browbone reduction.” In this procedure, the bone is just burred down. This procedure is for patients who have a very thick bone and can have several mm of bone removed by burring. This is not common, because most patients have only a very thin anterior wall. Still, it may be an option for patients who do not have much bossing to begin, and desire only a small improvement. The other patients who are candidates are those who do not have a developed frontal sinus. In this case, there is no “cave,” the shape is more like a big rock. In this case the bone can be burred a significant amount.
Type 3 Browbone Reduction
In this procedure, the anterior wall of the sinus is removed and then reset in a more posterior position. This is also called a frontal set back. Imagine that the front door to the cave is being moved further back into the cave. This is the procedure that the majority of transgender women need to get a significant reduction in brow bossing. The newly positioned bone is held into place with a tiny plate and screws. These can be titanium or plates that absorb over time.
Lateral Orbital Rim Reduction
Whether the patient has a Type 1 or a Type 3 browbone reduction, the lateral orbital rims usually need to be reduced as well. These bones are very thick and can generally be reduced significantly with a burr. Reducing the orbital rims helps open up the eyes. It allows light from above to illuminate the eyes. The eyes are brighter and appear softer, younger and more feminine.
Which procedure each patient needs is determined by a CT scan. The majority of patients need to have the bone reset (Type 3) in order to achieve a dramatic difference in the contour of the forehead. In the consultation with Dr. Rodman she will review your CT scan, your desired result, and determine the procedure that meets your needs.