Facial Feminization Surgery (FFS) in Austin, TX

Type 3 Cranioplasty – For reduction of a significant forehead Ridge. This technique requires burring away some of the bone but also making a cut into the bone repositioning it further back to flatten the ridge. The cut segment is then secured in place with thin metal plates and screws.

The Type 3 Cranioplasty – A Critical Appraisal

A Type 3 cranioplasty is a forehead contouring procedure that has been popularized by some surgeons. It is by no means the only way to address the brow ridge, and not all patients need that technique. By comparison to my preferred alternative, the Type 3 approach is more invasive and doesn’t fully treat the difference between a male and a female forehead. Often, male foreheads have a brow ridge in the bottom part and a depression or slope backward in the mid and upper part. A Type 3 cranioplasty only brings the ridge back to the lowest part of the forehead, which may be a non-feminine depression. The Type 3 technique does not address the fact that, while female foreheads should be smooth (i.e., no brow ridge), they still need to be full, round, and not sloped back. Dr. Weinfeld’s preferred method addresses these elements of the feminine forehead.

Forehead Contouring Preferred Method – Addition Subtraction Forehead Contouring (ASFC)

Dr. Weinfeld developed the Addition Subtraction Forehead Contouring (ASFC) technique as an alternative to the Type 3 cranioplasty. His goal was to develop an approach to FFS for the forehead that was less invasive and more comprehensive. ASFC is less invasive because it does not require cutting into the frontal sinus, and it is more comprehensive because it addresses both elements of the male forehead that need to be modified in the transformation to a female forehead. The brow ridge needs to be lowered, and the depression above it needs to be filled. In the ASFC technique, fat grafting is used to fill the depression (Addition), and a burr is used to flatten the ridge (Subtraction). The balance of adding and subtracting volume and contour with precision yields a more naturally feminine forehead that is rounded instead of flat and sloped, as can sometimes occur with the Type 3 approach.

Another benefit is that Addition Subtraction Forehead Contouring (ASFC) can be performed endoscopically; thus, a coronal or pretrichial incision is not required. A coronal incision is one across the top of the head. A pretrichial incision is one just at the frontal hairline. This is the incision that is needed for hairline advancement (forehead shortening). But not every patient wants or needs a hairline advancement, so not all patients desiring a femininely contoured forehead need a pretrichial incision. The endoscopic ASFC technique requires only small incisions (often less than ⅔ inch) that are well-hidden in the hair of the scalp. A guarded endo burr is used under direct endoscopic visualization to reduce the ridge in the lower part of the forehead. The burring of the bone can be combined with an open pretrichial incision when hairline advancement is planned or in patients who want the lateral orbital bone reduced. That cannot be done endoscopically.

Prior to doing that, fat is injected under the skin in the depression or dip that exists in most masculine foreheads just above the ridge. Fat is removed from parts of the body where there is excess. The abdomen and waist are often good donor sites because fat removal there can narrow the waist, which adds to a more feminine body shape. Often, women seeking FFS benefit from fat grafting to the temples. Adding fat there creates a more youthful appearance, and it reduces the apparent projection of the lateral orbital bones. Smoothing this area further projects femininity. FFS often involves fat grafting to the lower part of the face. That will be discussed elsewhere.

Can Unsatisfying Type 3 Cranioplasty Results Be Revised?

Yes.  Dr. Weinfeld has experience and success revising and improving Type 3 Cranioplasty results that did not deliver the results patients desired.  The ASFC technique can be used to enhance forehead that were not fully contoured by prior Type 3 cranioplasties.