Surgical modification of the upper face

Fronto-orbital plasty, a key procedure in the feminization process, is essentially a Mask-lift, i.e. a facelift of the upper third of the face, with the incision either in the scalp (intra-capillary incision) or at the hairline with the forehead (pre-capillary incision).

- the frontal bone approach, eliminating frontal humps and reducing the relief of the orbit, especially in the upper-external portion

- eyebrow lift, which, together with reaming of the orbital frame, opens up the eyes in a highly feminizing way

It is also possible, depending on demand, to make

- advancement of the hairline, with a reduction in the size of the forehead (on average 20 mm on the midline and 30 mm opposite the gulfs) and harmonization of the hairline by blurring the gulfs (only in the case of a pre-capillary approach).

- stretching of the outer part of the eyes(fox eyes)

In men, the frontal humps and periorbital bony arches are more pronounced, while in women, the forehead is straighter and the relief less pronounced.

3 elements can be modified by this intervention:

- the bony relief of the forehead and periorbital area

- hair implantation, i.e. the hairline

- eyebrow positioning by lifting or raising the eyebrow   

The results of this intervention are fundamental to the feminization process, and represent an essential stage in the process.

Fronto-orbital plasty surgical technique :

- under general anaesthetic

- the incision is either concealed in the hair, in which case it does not modify the hairline; or pre-capillary, i.e. at the hairline, allowing the hairline to be modified by lowering the hairline by 1 to 2 cm, combined with a reduction or elimination of the gullets, in which case the scar is located at the hairline,

- the bone of the forehead and the upper part of the orbits is exposed so that it can be reamed to reduce its relief

There are 3 techniques for flattening the forehead, which do not depend on the surgeon but on the patient's anatomy, which is extremely variable.

type 1 frontoplasty, thick bone walls, frontal sinusesx not very voluminous, reaming is sufficient

type 2 frontoplasty: to obtain a flat forehead, the anterior wall of the sinus must be locally depressed, without opening the mucosa (eggshell technique). The depressed areas are reinforced with bone powder harvested from the other milling areas.

type 3 frontoplasty: this involves cutting the anterior wall of the frontal sinus and depressing it for several millimeters. This is the most common technique, and consolidation is achieved either with micro-plates and screws, or, personally, by avoiding foreign material because of the risk of infection.

- forehead muscles and frown lines are weakened to reduce forehead wrinkles,

- eyebrow enhancement 

- +/- lateral eye stretching can be performed to modify the gaze

Operating Suites

- hospitalization during the night following the operation is necessary

- periorbital edema and ecchymosis may occur, as well as a reduction in forehead sensitivity; it may take several months for everything to return to normal.

- post-operative pain is moderate and responsive to the usual analgesics

- Strict rest is required for about ten days, at which time the stitches or staples are removed, followed by one to two weeks off work and 1 month off physical activity.

- the part of the incision located in the scalp is closed with staples, the frontal part at the hairline is sutured with an intra-demic suture using absorbable thread, the scar is barely visible in most cases

Other possible procedures associated with upper facial modification:

- mainly hair transplants on balding areas, particularly the gulfs (if they are very pronounced, surgery is insufficient and hormone therapy does not necessarily prevent further hair loss) or on scars. A more time-consuming scalp extension technique may be proposed, but a hair substitute is often the best solution;

- modification of the shape of the eye by external canthopexy (lateral stretching).

- botulinum toxin injections in the forehead area to erase expression lines in the forehead and give a firmer facial expression

- hyaluronic acid injections in the periorbital area or temples

Examples of results:

preoperative aspect

post-operative appearance (fronto-orbital plasty with capillary advancement and mandibular plasty)

preoperative aspect

post-operative appearance (fronto-orbital plasty without capillary advancement and mandibular plasty)

preoperative aspect

post-operative appearance (fronto-orbital plasty with capillary advancement, rhinoplasty and mandibular plasty)

pre-op appearance post-op appearance