Frontal Bone Remodeling for Gender Reassignment of the Male Forehead: A Gender-Reassignment Surgery

Abstract

Gender-reassignment therapy, especially for reshaping of the forehead, can be an effective treatment to improve self-esteem. Contouring of the cranial vault, especially of the forehead, still is a rarely performed surgical procedure for gender reassignment. In addition to surgical bone remodeling, several materials have been used for remodeling and refinement of the frontal bone. But due to shortcomings of autogenous bone material and the disadvantages of polyethylene or methylmethacrylate, hydroxyapatite cement (HAC) composed of tetracalcium phosphate and dicalcium phosphate seems to be an alternative. This study aimed to analyze the clinical outcome after frontal bone remodeling with HAC for gender male-to-female reassignment. The 21 patients in the study were treated for gender reassignment of the male frontal bone using HAC. The average age of these patients was 33.4 years (range, 21–42 years). The average volume of HAC used per patient was 3.83 g. The authors’ clinical series demonstrated a satisfactory result. The surgery was easy to perform, and HAC was easy to apply and shape to suit individual needs. Overall satisfaction was very high. Therefore, HAC is a welcome alternative to the traditional use of autogenous bone graft for correction of cranial vault irregularities.

Evaluation and treatment of facial feminization surgery: part I. forehead, orbits, eyebrows, eyes, and nose

“…Lastly, group IV foreheads (1%) [24] are characterized by such a slope that setback cannot achieve the necessary contour. Thus, augmentation with autogenous bone or with alloplastic materials, such as methylmethacrylate, polyethylene, or hydroxyapatite cement, is needed to establish forehead convexity [15,[25][26][27]. In the senior author's (JCL) experience, 90% of patients require frontal bone osteotomy and setback.…”

Decompressive Cranial Vault Remodeling in Osteosclerotic Robinow Syndrome

“…The technique of endocranial burring may be performed during cranioplasty in a more limited capacity and is a well-established approach for frontal sinus cranialization. Extracranial burr contouring of the frontal, zygomatic, and mandibular bones has previously been described as a component of gender-affirming surgeries in male-to-female patient transitioning, as well as for aesthetic improvement or feminization of prominent foreheads (Ousterhout, 1987; Hoenig, 2011; Han and Park, 2014; Salgado et al, 2018). However, endocranial contouring with a burr and osteotome is not typically used as the primary approach to calvarial expansion, as done in this case; the first described surgical correction of osteosclerotic Robinow syndrome.…”

Forehead/Brow Reduction or Augmentation with Custom Implants for Enhanced Facial Profileplasty

“…Its high cost limits it use in large augmentations for many patients ($100 per gram vs. $10 per gram for PMMA). 3,4 Regardless of the bone cement material used, it needs to be shaped to create the desired forehead shape. Besides the vertical inclination and the creation of a visible brow ridge if needed, the often overlooked part of forehead augmentation is its merging up to or across the anterior temporal line.…”

“…But most male to female brow bone reductions of any significance require the welldescribed type III bone flap setback technique. 7,8 But the bone flap setback alone is often not enough to get a definitive gender change in the FFS patient. As part of the brow recontouring, the lateral or tail of the brow bone must be reduced to allow a more upward sweep to the tail of the eyebrow.…”