Abstract
PURPOSE: The upper third of the face has several characteristics, including hairline shape, eyebrow position, and forehead protrusion, that confer feminine identity and thus, may be altered to address gender dysphoria. METHODS: A systematic literature review was conducted to identify articles that discussed techniques and clinical outcomes when performing procedures for feminization of the upper third of the face. RESULTS: 22 studies were included in the final analysis. Priorities of forehead feminization entail reduction of the frontal bossing, opening of the frontonasal angle, orbital contouring, brow lifting, and hairline advancement. 85 patients were included within the cohort. Pre-tricheal incision was utilized for majority of patients (93%). For brow lift, local tissue rearrangement was used in 53 (62%) patients, while bilateral bone channels and coronal brow lift were performed in 29 (34%) and 3 (4%) patients respectively. Autologous bone graft (split calvarial) was used in 48 (56%) of patients. There were one complication (mucocele) and twelve revisions. The mean follow-up period was 10 months. CONCLUSION: Our multi-pronged analysis presents an updated review of the principles of forehead feminization and may help plastic surgeons in their practice of feminization of the upper third of the face.
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