The Upper Third in Facial Gender Confirmation Surgery: Forehead and Hairline

Abstract

The upper third of the face contains 2 features that are particularly important for facial gender recognition: the frontonasoorbital region and the hairline. The supraorbital ridge, which determines the position and exposure of the eyebrows, is almost invariably more developed in the male than in the female. Surgical modification of the frontonasoorbital complex, considered a standard procedure in facial feminization, is reliable and predictable, and also delivers satisfactory results that are stable over time. A prototypical male hairline has an M-shaped pattern compared to the more rounded shape often seen in female hairlines. Feminization of the hairline requires minimizing the temples as well as rounding out the overall shape, optimizing hair density, and occasionally changing the height of the hairline. This article provides an update on our forehead reconstruction technique and our experience in the treatment of hairline redefinition.

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

“…Other techniques to modify the hairline include simultaneous hair transplantation with forehead reconstruction using two modified coronal approaches [20,21]. There are some differing opinions with respect to the timing of hair transplantation, with some groups recommending immediate transplantation [20] and others suggesting that deferred hair transplantation improves engraftment rates [22] and results in fewer complications [19,23].…”

ESSM Position Statement “Sexual Wellbeing After Gender Affirming Surgery”

“…Forehead reconstruction and hairline corrections-approached through a coronal or hairline incision 164 open up the upper face. 165 , 166 , 167 , 168 Lower jaw contouring corrects the lower face by reducing the transverse and vertical dimensions of the jaw, softening the angle of the mandible, improving jawline contour and adjusting of the volume, format and position of the chin. 169 , 170 , 171 , 172 , 173 , 174 , 175 , 176 , 177 , 178 The midface may be addressed with rhinoplasty.…”

Masking Gender: The Impact of Facial Coverings on Gender Recognition

“…Virtual reality can also be used to assist with surgical impact on the improvement of their gender dysphoria. 7 No set of operations can eliminate masculinity of the upper third of the face, but interventions can improve feminine contour and oftentimes can play an important role in facial gender recognition. 2 The face mask is essential during the COVID-19 pandemic.…”

“…Forehead feminization surgery, when applied properly to appropriate patients, can have a substantial impact on the improvement of their gender dysphoria. 7 No set of operations can eliminate masculinity of the upper third of the face, but interventions can improve feminine contour and oftentimes can play an important role in facial gender recognition. 2…”