orbital bony contouring
One of the most obvious characteristics between a male and female forehead is a more prominent brow bone in males. There are also noticeable differences in eyebrow shape and hairline pattern.
Orbital Bony Contouring provides a very dramatic feminizing result, along with the Forehead Lift and Hairline Lowering procedures, pioneered by Dr. Mayer more than 25 years ago. This has a striking result — truly transforming the appearance of the upper third of the face. A masculine forehead has a heavier brow ridge and, by softening this, a lighter, softer, more feminine appearance is obtained.
Dr. Mayer requires that a lateral skull X-ray be taken to determine the distance between the sinuses and the brow bone, so that he can accurately determine how low he can take the brow bone. An incision is made at the hairline, the forehead is loosened for full access to the brow bone, and the brow bone is shaved. The forehead is then lifted, the hairline advanced down, and sutures are placed at the hairline. Using a technique that Dr. Mayer developed, the hair is forced to grow through and in front of the incision, which ultimately will conceal the incision. Therefore, there is no need for any hair grafts at the hairline. The hairline is created in an irregular fashion, the way that a natural hairline looks.
A forehead lift is often performed on transgender female patients to raise the brows to a more feminine position. Orbital bony contouring, or a reshaping of the bone underneath the eyebrows, is often combined with a forehead lift to soften the area around the eyes. (For these patients we will require a skull X-ray prior to surgery). In addition, many of our patients would like to lower their hairline (since men tend to have a larger forehead than women) and we often combine a forehead lift with hairline lowering.
Through the unique hairline forehead lift procedure we developed, these procedures can all be performed at the same time allowing us to resolve these related problems simultaneously. The incision is naturally concealed within the hairline.
Please note that some patients have more extensive male-pattern baldness that may require other hair replacement procedures to correct. These procedures can often be done in conjunction with a forehead lift as well.
forehead reduction hairline lowering
The hairline lowering procedure is the “brain child” of Dr. Toby Mayer, created more than 30 years ago. It is even described in his medical textbook, Aesthetic and Reconstructive Surgery of the Scalp. This book is considered the bible for aesthetic and reconstructive surgery of the scalp including hairline lowering. At the same time, he developed an innovative technique that allows the hair to grow through and in front of the incision, so no scar is visible. This technique, called the “Irregular Trichophytic Incision,” has been performed by Dr. Mayer on numerous actors, actresses, and models all over the world. You see the doctor's results daily on camera and on the big screen.
When the scalp is tight, tissue expansion gives Dr. Mayer the opportunity to advance the hairline without tension to avoid a visible hairline scar. Some doctors who do not perform tissue expansion make more extensive scalp incisions within the scalp which limits the choice of hairstyles.
Many women have a large forehead secondary to a congenitally high hairline or a hairline that has been elevated after previous cosmetic surgery. Our hairline advancement procedure has been developed to lower that hairline and bring the proportions of the face into balance. With the aging process, the high hairline is accentuated giving women a balding/masculine appearance. The hairline advancement can be performed as an isolated procedure or at the same time as a hairline forehead/brow lift.
With this technique, an incision is made within the hairline and the scalp advanced after mobilization of the hair bearing tissue. Hair follicles are buried under the skin closure at the completion of the operation so hair will grow through and in front of that line, giving patients total freedom of hair styling. In some instances where there is not enough elasticity in the scalp to provide adequate advancement, a tissue expander can be placed under the hair-bearing scalp. The expander is slowly filled and, over time, will stretch the scalp to provide the needed advancement of the hair-bearing scalp to lower the hairline. After several weeks, the tissue expander is removed and the hairline is advanced to its correct position, utilizing the camouflage incision at the hairline.