I think there are very few trans women who would not profit from a surgery of the bones of brow, forehead and orbital bones above the eyes. I think for Europeans, the brow ridge is less important than for others as its a genetic trait in Europe (I personally think it has to do with the Neanderthal population bringin in some parts of the local gene pool, while other regions did not have that). For other ethnicities however it is more important. But even for Europeans, I believe that its not so much the brow ridge that is important, but the brow bossing, the bones around the eyes and the shape of the forehead. Many women have significant brow ridge, but it is located closer to the eyes in males than in females, causing an "overhang" over the eyes. Also it can increase the perception of a fleeting forehead, if it already is fleeting a bit. A more vertical forehead shape is more feminine, even with a brow ridge.
For example she has a rather pronounced brow ridge, but its not identified as male at all, even though her lower facial features are not overwhelmingly feminine, but the brow ridge sits higher than in men and her forehead is not sloping back, her hairline is oval and not M shaped.


So in the end, if people misgender you or if you feel dysphoric about the face and a particular feature, then a surgery makes sense, you can ask several surgeons what they recommend and get simulation photos done

Quote from: Han on January 09, 2018, 12:18:36 AM

I'm not you ,You are not me .Not everyone is going to need forehead type 3 surgery.Fortunately last year when I had my FFS ,my surgeon checked my X-ray and told me If I want do my brow bridge I only need a Minimum  brow shave   


But thanks for your explanation about type 3 thought

I never said everyone is going to need it. I said that you don't make a decision about which type you get based on preference, but rather based on which type your forehead is. If you had informed us that you'd already had an X-ray, this entire conversation could have been a spared expense.

Quote from: IsabellaSwan on January 09, 2018, 08:46:48 PM
I never said everyone is going to need it. I said that you don't make a decision about which type you get based on preference, but rather based on which type your forehead is. If you had informed us that you'd already had an X-ray, this entire conversation could have been a spared expense.

Thank you for your participating .Have a good day

Quote from: Han on January 10, 2018, 09:09:28 AM
Thank you for your participating .Have a good day

It would be really helpful to see your X-ray to see what type of forehead structure you were dealing with.

Quote from: myfairlady49 on January 10, 2018, 06:17:49 PM
It would be really helpful to see your X-ray to see what type of forehead structure you were dealing with.

Yes, and this is why strangers on the Internet is probably not a great place to get this sort of advice.

In my particular case, reconstruction of the bone plate covering the frontal sinus is the right way to go, as the bone is not thick and the sinus cavity is fairly large.   If the brow ridge were formed by thick bone backed by a narrow sinus cavity, simply removing bone would be the right way to go.

This is something best determined between an individual and their surgeon, over X-ray or CT scans and coffee.  (Been there, did that!)

Let's not forget about the many surgeons who recommend brow shaving because they can't adequately perform a forehead reconstruction, or is that not a probldm anymore? Also, the doctors that claim to do it, yet never seem to achieve results worthy of Dr O, Dr Suporn, Dr Van der Dussen etc. This used to be a big problem a few years ago.

Yes its a problem. Somehow the "type 1 versus type 3" distinction moved from the original Dr O definiteion of  how to do the surgery depending on the physiology of a patient to "how prominent is the bossing, if it is little we just do type 1".
So 2 surgeons recommended me type 1 wothout even knowing my X rays or scans just by looking at photos or me in real life and judging this from the lack of pronounced brow ridge. The scans however show a very thin brow bone - thin enough that I am even worried to get some titanium mesh when I do the type 3 procedure to stabilize it. So they could not know what is needed there unless they basically would have kept the sinus as it is and just shave the orbitals and temporal ridges - that may have worked, considering the brow bossing is not large, but of course it would not have adressed the brow bossing at all then, I suppose.
I did however see a few results of forehead work with shaving only that were interestinly quite different from before, even though there was some brow bossing visible. Not sure what they did - shave in the right parts, fill some parts with bone cement maybe... Dr Z only does shaving, as he works endoscopically... some people in Korea also do the same thing...
Generally I would say though the type of work needed depends on a) if you need setback at all and then b) what thickness your sinus bone and sinus cavity have

Yes, exactly as I thought. I remember some girls talking about "not wanting a type 3", as if it was merely a procedure, instead of a forehead type that requires a certain procedure. Certainly, many of us also call the procedures used on the different types of foreheads "type #", but it is important to remember that the forehead dictates the technique that should be used, not vice versa, ESPECIALLY in type 3 cases. Perhaps type 1 foreheads could technically speaking be treated with an osteotomy (I don't know for certain), but it just seems wholly unnecessary, doesn't it. However, merely shaving the bone on type 3 foreheads (i.e. applying the technique used on Type 1 foreheads) is at best ineffective, and at worst potentially dangerous. Dr Suporn actually developed a technique that is proprietary and exclusive to him, where he resets the forehead in type 1 patients. From how I understand it, he shaves the bone and then, with a controlled fracture, "pushes" the forehead further back. He doesn't even mention type 2 on his page, so I'm assuming it's because he perhaps doesn't really treat foreheads with bone paste, and therefore lets the sinuses decide, so to speak. I can understand this, as I have been unimpressed with the alleged type 2 foreheads and treatments I have seen. It is a rather rare forehead type, though, because the entire idea behind type 2 is that your forehead projection is already within the normal female range, so it's very possible that I have seen results of women who weren't truly candidates for this procedure. Please read Dr O's book for more information.

Another area where you girls need to be mindful is the chin! Some surgeons only perform burring procedures, trying to shave down the chin, but you can only shave so much without causing damage, and if your face needs shortening (which most trans faces probably do), you need a sliding genioplasty. This is why it's so important to go to someone who specializes in bone work - they won't cut corners or have an incentive to sell you procedures that will ultimately underwhelm you. Maxillofacial and craniofacial surgeons who are also certified in aesthetic plastic surgery.

I have thought hard about these surgeries etc my personal opinion is i am going to wait 2 to 3 years after hrt has took affect, then make a judgement then i want to transition just as much as everyone else but i want to do it graceful, if that makes sense. But what i do will be in my own time when i feel i need to i am living my life for me and no one else, and everyone looks different so there is no right or wrong. There is just you and do what makes you happy.

In forehead feminisation, the object is to remove the brow bossing.

You can't tell from the outside whether the bone over the frontal sinus is thick or thin. In most people it is thick - between 2.6 and 2.9 mm. This means that in the vast majority of cases, it's not possible to remove a significant amount of bossing just by shaving down the bone.

Even in a case where there is no frontal sinus (a small percentage of the population) it can still be a good idea to do a forehead reconstruction. This is because bone is generally hard on the outside and softer in the middle. If you just use shaving, you make that strong outer layer thinner, and that can weaken the forehead, but it you reconstruct the forehead, you move that solid layer back, retaining its full thickness and full strength. Within a few weeks of the surgery, your forehead is a strong as it was pre-op, and that wouldn't be the case if you had only shaved down the hard outer layer.

Many people think that a forehead reconstruction is a much bigger and more dangerous operation than shaving. This isn't really the case. Shaving can thin the bone excessively, even in cases where there is no frontal sinus, and you are more likely to end up having a revision because shaving alone has a limited feminising effect in most cases.

Some surgeons use a shave and fill technique - they shave the bone down and then add fillers around the bossing to disguise it. This does result in a smoothly rounded forehead which is feminine, but it also often results in a forehead that bulges forwards unnaturally (I call this a "dolphin forehead"), and it can leave your eyes deep-set.

Everyone is different. If your outer bone layer is really thick, you might get away with shaving without compromising the strength, but that would be unusual - in the vast majority of cases, you have thin bone over a frontal sinus, and the only way to feminise that effectively, and safely, is to set the bone back with a reconstruction.

Some people also worry that the frontal sinus is a pristine cavity that should not be exposed, but actually, your frontal sinus is not sealed - it is open to the nose so outside air circulates around it all the time.

Keep in mind that some surgeons who don't do forehead reconstructions tell all their patients that they don't need a forehead reconstruction.

Quote from: anjaq on January 09, 2018, 04:03:43 PM
I think there are very few trans women who would not profit from a surgery of the bones of brow, forehead and orbital bones above the eyes. I think for Europeans, the brow ridge is less important than for others as its a genetic trait in Europe (I personally think it has to do with the Neanderthal population bringin in some parts of the local gene pool, while other regions did not have that).

Actually, East Asians have more Neanderthal DNA than Europeans, so that's probably not the reason. Interesting theory though.

https://www.nytimes.com/2015/02/20/science/a-new-theory-on-how-neanderthal-dna-spread-in-asia.html?_r=0

My point exactly, Alexandra! And some of the surgeons who allegedly do forehead reconstructions aren't skilled enough to do them well. There's a popular, but cheap surgeon I see all over this forum, and his work makes no difference, yet everyone sings him praises.