Forehead and Hairline Surgery for Gender Affirmation

BACKGROUND: With the improvement of the results of surgical treatment for facial transformation globally, many female transgender individuals seek surgical management for their faces, especially the forehead and hairline. These are critical aspects in the surgical management of the frontonasal-orbital area because the anatomy of the frontal sinuses is complicated and shows a high variation. METHODS: The author presents a grid method to measure the boundary of the frontal sinus in the female transgender forehead contouring and reconstruction. The surgical technique of forehead set back and simultaneous hairline advancement is described. RESULTS: Between January 2015 and December 2017, there were 23 cases of forehead and hairline feminization procedures by the author. Patient age was between 20 and 74 years (mean 32.56). There were 11 Asians and 12 White patients. Eleven patients underwent supraorbital ridge contouring, and 12 underwent forehead reconstruction. Hairline advancement was simultaneously performed in 9 patients, and 3 underwent forehead augmentation at the supraorbital ridge. The postoperative follow-up time ranged from 3 weeks to 18 months. CONCLUSIONS: The key to the success of forehead contouring surgery in female transgender patients is the precise measurement of the boundary of the frontal sinus. This technique offers a practical way to estimate the frontal sinus sizes and shapes to avoid intraoperative complications and reduces the possibility of surface irregularity.