Forehead Contouring Surgery

Forehead contouring in London is designed to reshape the brow and forehead, creating a smoother, more balanced, and feminine appearance. Performed by our specialist surgeons using advanced techniques, the procedure is tailored for precise, natural-looking results.

Forehead Contouring Surgery in London

Forehead contouring surgery — also called brow bone reduction, feminising cranioplasty, or frontoplasty — reshapes the bony structure of the forehead to create a softer, more traditionally feminine profile. It addresses the most anatomically distinctive difference between masculine and feminine facial skeletons: the prominence of the brow ridge and the projection of the forehead bone itself.

This isn’t a soft-tissue procedure. Forehead contouring involves actual modification of the frontal bone — thinning the bone where it’s thick enough, or in the most common scenario, removing the anterior wall of the frontal sinus, reshaping it, and setting it back into a less prominent position. It’s one of the most technically demanding procedures in facial feminisation and one of the most impactful in terms of visible change.

Forehead contouring is most commonly performed as part of for trans women and non-binary patients. Cisgender women with congenitally prominent brow ridges also seek this procedure. Because outcomes depend on matching the right surgical approach to the patient’s specific forehead anatomy — typically classified using the Ousterhout system — it requires a surgeon with specific training and experience in feminising cranioplasty.

At Centre for Surgery, forehead contouring is performed at our Baker Street clinic under general anaesthetic, typically as part of a coordinated FFS plan. It’s often combined with , , and . Typical pricing is £10,000–£15,000 for standalone forehead contouring, with combined-procedure pricing at consultation.

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What is forehead contouring surgery?

Forehead contouring surgery modifies the bony architecture of the forehead — primarily the brow ridge (supraorbital rim) and the anterior wall of the frontal sinus — to create a softer, more traditionally feminine contour. It’s the most anatomically significant procedure in upper-face feminisation, because the forehead bone shape is one of the key visual cues the brain uses to read a face as masculine or feminine.

The procedure is performed through a coronal incision — a long incision hidden across the top of the scalp from ear to ear, typically inside the hairline — or sometimes a pretrichial incision just in front of the hairline (which allows simultaneous hairline lowering). The scalp is lifted forward to expose the frontal bone.

From this point, the specific technique depends on your forehead anatomy:

The most common approach by far is the anterior-wall-setback — a "Type III" cranioplasty in the Ousterhout classification. This is the procedure most trans women undergoing forehead feminisation will have.

Masculine foreheads typically show: prominent brow ridge (pronounced superciliary arch), deeper-set eyes (because the ridge projects forward), a flatter or more vertical forehead, a more acute nasofrontal angle (the junction between forehead and nose), and more pronounced temples. Feminine foreheads typically show: smoother, more continuous curve from hairline to brow, less prominent brow ridge, slightly more open nasofrontal angle, and a rounder overall contour.

Soft-tissue procedures (brow lift, anti-wrinkle injections) can’t change any of this. The underlying bone has to be physically modified. That’s what forehead contouring does.

Forehead contouring is specifically about the bony contour of the forehead and brow ridge. It doesn’t address: hairline position (needs hairline lowering), brow position (needs brow lift — often combined with forehead contouring for comprehensive upper-face feminisation), small bony bumps on the forehead surface (may need ), upper eyelid skin excess (blepharoplasty), or wrinkling (anti-wrinkle injections or skin treatments).

Forehead Contouring Before & After

A selection of forehead contouring results from our surgeons. A wider gallery is available at your consultation — we only publish photos of patients who have given written consent.

A well-executed forehead contouring produces a smoother, rounder forehead contour with a softer brow ridge. The change is subtle in some views and dramatic in others — profile views often show the biggest visible difference because the sagittal (side-to-side) shape of the forehead changes most.

The nasofrontal angle opens slightly, the eyes look less deep-set, and the upper face reads as more traditionally feminine. Combined with hairline lowering (which shortens the forehead) and brow lift (which raises and reshapes the brow), the combined upper-face change is often transformative.

What well-executed forehead contouring shouldn’t do is make the forehead look artificial, overly flat, or obviously operated on. The goal is a natural, harmonious curve that fits the rest of the patient’s face.

Masculine versus feminine forehead anatomy

Understanding why forehead contouring works requires understanding the anatomical differences between typically masculine and typically feminine foreheads. These differences are bony, not soft-tissue — which is why bone modification is the only way to change them.

The most visually distinctive difference. Masculine foreheads have a pronounced supraorbital ridge — a horizontal bony prominence above the eye sockets — that creates the characteristic "brow bossing" seen in male skulls. Feminine foreheads have a much less pronounced ridge, with a smoother transition from forehead to orbital rim.

Behind the brow ridge lies the frontal sinus — an air-filled cavity within the frontal bone. In masculine anatomy, the anterior wall of the frontal sinus tends to project further forward, contributing to brow ridge prominence. In feminine anatomy, this projection is typically less.

Masculine foreheads often slope backward more, with a more vertical or backward-tilted profile. Feminine foreheads are typically more rounded with a gentler forward curve.

The angle where the forehead meets the nose. Masculine faces have a more acute angle (around 130 degrees) while feminine faces show a slightly more open angle (around 134 degrees, on average). This subtle difference is one reason why forehead contouring combined with rhinoplasty produces a more harmonious feminine result than either alone.

The outer portion of the superior orbital rim (around the outer corner of the eye socket) tends to be more angular and prominent in masculine faces, creating a squarer eye-socket appearance. Feminine orbital rims are rounder. Forehead contouring often includes burring of the outer third of the superior orbital rim to achieve this rounder appearance.

Masculine temples can be more prominent or angular; feminine temples tend to be softer. This is sometimes addressed during forehead contouring, but sometimes separately with fat grafting.

Not a bony difference, but closely related. Masculine hairlines tend to form an M-shape or show bitemporal recession, while feminine hairlines are typically rounded and lower. This is addressed by rather than by forehead contouring, though both are often performed together through a combined incision.

Effective forehead feminisation isn’t one single technique — it’s a carefully matched combination of bony modifications chosen based on the patient’s specific anatomy. The same external appearance can result from different underlying bony shapes, and the right surgical approach depends on what’s actually there.

The Ousterhout classification and matching surgical approach

Forehead feminisation outcomes depend enormously on matching the right surgical technique to each patient’s specific bony anatomy. The most widely used framework for this is the Ousterhout classification, developed by Dr Douglas Ousterhout in 1987 and still central to FFS today. The classification identifies four forehead morphologies (Types I through IV), each with a specific surgical approach.

Anatomy: Brow ridge prominence without a significant frontal sinus — either the patient lacks a frontal sinus entirely, or the anterior wall of the sinus is thick enough that the prominent bone can be safely removed without entering the sinus.

Procedure: Direct burring (drilling down) of the prominent bone using a high-speed surgical drill. The sinus isn’t entered. Recovery is generally simpler than Type III because no bone graft or fixation is needed.

Anatomy: Mild to moderate brow prominence with a thin anterior sinus wall and sometimes a concavity above the brow ridge.

Procedure: Limited burring of the bony prominence (care taken not to enter the sinus), sometimes combined with augmentation of the concave area above.

Anatomy: Significant forward projection of the anterior wall of the frontal sinus, creating substantial brow bossing. The anterior wall is too thin and too projecting to address with burring alone — burring enough to address the prominence would break through into the sinus.

Procedure: The most technically demanding forehead feminisation technique. The anterior wall of the frontal sinus is removed in one piece, reshaped (contoured to a less-prominent shape), and set back into a more recessed position. It’s fixed in place with small titanium plates and screws, or sometimes with bone pate (small bone shavings used as filler) or split cranial bone grafts where bony gaps need filling. The setback is typically 4-7 mm.

This procedure — Type III cranioplasty or anterior table setback — is what most trans women undergoing forehead feminisation will have. It requires specific training and experience because it involves entering the frontal sinus safely, handling the thin anterior wall bone without fragmenting it, and reconstructing it to a natural contour.

Anatomy: Small, flat, or under-projected forehead that needs augmentation rather than reduction.

Procedure: Augmentation with bone cement, custom implants, or fat grafting to build up the contour. This is the rarest type.

Recent literature has added an "intermediate" type for patients with anatomy that sits between Type I and Type III — patients whose anterior sinus wall is thinner than Type I patients but whose sinus is shallow enough that a full Type III setback would over-recess. This is addressed by frontal bone recontouring supplemented with cranial bone graft to reconstruct anterior wall defects.

Your surgeon will assess forehead morphology at consultation based on:

CT imaging isn’t always essential (many surgeons operate without it) but is helpful for detailed virtual surgical planning in complex cases, or where there’s a concern about anatomical variants.

A surgeon who performs the same technique on every patient — usually either "just burring" regardless of anatomy, or "always Type III" — will over- or under-treat a significant proportion of patients. Good outcomes depend on matching the technique to the anatomy. This is one of the clearest ways to judge surgical experience in forehead feminisation.

Am I suitable for forehead contouring?

Suitability for forehead contouring depends on your anatomy, motivation, general health, and expectations. Here’s an honest framework.

You are likely suitable if: you have a visibly prominent brow ridge or bossing, a frontal bone contour that reads as typically masculine, or a forehead shape that doesn’t match your gender identity or aesthetic preferences.

You are less suitable if: your concern is primarily about forehead wrinkles (not a bony issue), the shape of your hairline (hairline lowering addresses this), the position of your brows (brow lift), or small bony bumps on the forehead (osteoma removal). A careful examination at consultation distinguishes between these.

Forehead contouring is most commonly performed as part of facial feminisation surgery for trans women and non-binary patients. Cisgender women with congenital brow bossing are also candidates, as are patients with post-traumatic asymmetry. Your surgeon will listen to your goals and make sure the procedure matches what you’re actually looking for.

If forehead contouring is part of a broader FFS plan, your surgeon will help you prioritise procedures based on your priorities, anatomy, and what can safely be combined in one sitting. Forehead contouring is often combined with hairline lowering and brow lift (both sit near the same incision), sometimes with rhinoplasty (the coronal approach gives access to the nasofrontal angle for refinement), and less often with lower-face FFS procedures (which are usually staged separately).

Good general health — forehead contouring is a significant surgery involving bone work. Stable weight. Non-smoker (or willing to stop for at least 4 weeks before and 2 weeks after). Uncontrolled blood pressure must be addressed. Flag any bleeding disorders, sinus disease (critical for Type III cases where the sinus is entered), previous head or forehead surgery, history of migraines or headache disorders, and all medications.

We don’t operate on patients under 18, and the facial skeleton must be fully mature (typically achieved by late teens to early 20s). Most forehead contouring patients are between 20 and 50.

Forehead contouring produces a significant, measurable change in the bony contour. Combined with hairline lowering and brow lift, upper-face change can be transformative. Standalone forehead contouring without other FFS procedures produces a more limited change. Patients expecting complete facial transformation from forehead contouring alone may be disappointed; those who understand it as one component of a coordinated plan tend to be very satisfied.

Patients under 18, patients with unresolved frontal sinus disease, patients with bleeding disorders, patients with unrealistic expectations of transformation from forehead work alone, active smokers unwilling to stop, patients whose concern is actually soft-tissue or hairline rather than bony contour, patients seeking forehead contouring for body-dysmorphic reasons. For the last category, our article on is worth reading.

Preparing for your forehead contouring surgery

Forehead contouring is a significant bone procedure. Thorough preparation improves both surgical safety and recovery quality.

Our pre-op assessment team will contact you to confirm fitness. Medical history, examination, bloods if indicated. For Type III cases where the frontal sinus will be entered, flag any history of chronic sinusitis, previous sinus surgery, or current sinus symptoms. CT or CBCT imaging may be requested to plan the procedure in detail.

Stop for at least 4 weeks before surgery and 2 weeks afterwards. Smoking reduces scalp blood supply and bone healing capacity — both critical for forehead contouring. Smokers have significantly higher rates of wound breakdown, visible scarring, delayed bone healing, and infection.

Stop aspirin, ibuprofen, and other NSAIDs for two weeks. Stop fish oil, vitamin E, ginkgo biloba, garlic, St John’s wort. Paracetamol is fine. Flag any prescribed blood thinners for management with your GP.

Stop alcohol for at least 3 days before and 3 days after surgery.

Follow fasting instructions (no food 6 hours before, clear water up to 2 hours before) for general anaesthetic. Shower and wash hair before arriving. No makeup or hair products. Wear comfortable button-front clothing.

Expect significant forehead swelling — this peaks at 2-4 days and can be substantial. Bruising commonly extends down into the upper eyelids and sometimes the cheeks. Forehead feels tight, numb, and unfamiliar during initial healing. The final contour is obscured by swelling for 4-6 weeks, with subtle changes continuing for 3-6 months as the last residual swelling resolves and the bone healing finishes.

The forehead contouring procedure

Forehead contouring is performed at our Baker Street clinic under general anaesthetic. The procedure typically takes 2 to 4 hours for standalone forehead contouring; longer when combined with hairline lowering, brow lift, or other FFS procedures.

You’ll arrive at the clinic at your scheduled time. Our nurse will admit you and run through observations. Your surgeon will examine you, confirm the plan, and mark the planned incision line and any specific landmarks.

General anaesthetic (TIVA) is administered. Local anaesthetic with adrenaline is infiltrated along the incision line and across the scalp to reduce bleeding. Hair is held with ribbon ties — no shaving. The scalp and forehead are prepped and draped.

The incision is placed either:

The scalp is lifted forward in a plane above the periosteum, exposing the frontal bone, brow ridges, and — depending on extent — the nasal bones and orbital rims. Landmarks like the supraorbital neurovascular bundles are carefully identified and preserved.

The prominent bone is thinned using a high-speed surgical drill with a diamond burr. Bone pate (fine bone shavings saved from the drilling process) may be used to fill any small contour irregularities. The frontal sinus isn’t entered.

Similar burring approach for the prominence, with care not to enter the sinus. Any concavity above the prominence may be augmented with bone pate, bone cement, or occasionally small implant material.

The boundaries of the frontal sinus are identified by direct observation through the thinned bone or with sinus imaging guidance. The anterior wall of the sinus is cut around these boundaries using a fine oscillating saw to create a single free piece of bone.

The removed bone is recontoured on the operating table — the convex curve flattened to a more feminine profile — using the surgical drill.

The reshaped bone is placed back into position, but set back (recessed) into the sinus. The setback is typically 4-7 mm depending on the degree of bossing being addressed.

The repositioned bone is fixed in place with titanium microplates and screws, or sometimes with absorbable fixation hardware. Any bony gaps at the edges are filled with bone pate or split cranial bone graft.

Additional bony contouring of the brow ridge edges and outer superior orbital rim is performed to refine the feminine curvature.

The under-projected forehead is built up using bone cement, custom patient-specific implants, or OnabotulinumtoxinAAbobotulinumtoxinAIncobotulinumtoxinAPrabotulinumtoxinALetibotulinumtoxinARimabotulinumtoxinBHyaluronic Acid FillersCalcium Hydroxylapatite FillersPoly-L-lactic Acid FillersPolymethylmethacrylate FillersAutologous Fat GraftingForehead Lines TreatmentGlabellar Frown Lines TreatmentCrow's Feet TreatmentBunny Lines TreatmentChemical Brow LiftLip FlipGummy Smile CorrectionMasseter ReductionJaw SlimmingDimpled Chin SmoothingCobblestone Chin SmoothingNefertiti Neck LiftMicro-BotoxMesotoxHyperhidrosis TreatmentChronic Migraine ReliefBruxism TreatmentTMJ TreatmentCervical Dystonia TreatmentNeck Spasm TreatmentBlepharospasm TreatmentLip AugmentationLip ContouringCheekbone EnhancementTear Trough FillersNasolabial Fold SofteningMarionette Line FillersLiquid RhinoplastyNon-Surgical Nose JobJawline ContouringJawline DefinitionChin AugmentationTemple VolumisingHand RejuvenationAcne Scar Subcision Filling grafting. Technique depends on the degree of augmentation needed.

Regardless of forehead type, the outer third of the superior orbital rim is typically burred to create a rounder, more feminine orbital shape. This can subtly lift the lateral brow and open up the lateral eye appearance.

Forehead contouring is most often combined with:

The scalp is redraped. If hairline lowering has been done, the excess forehead skin is excised. The incision is closed in multiple layers — deep sutures to reduce tension, skin sutures or staples for the surface. A light head dressing is applied, often combined with a soft headband for the first few days.

You’ll wake in our recovery area and be monitored as the anaesthetic wears off. Cold compresses applied. Most patients stay one night at the clinic for monitoring after forehead contouring (particularly Type III cases) — this is discussed at consultation. Discharged with your post-op pack, pain relief, written instructions, and 24-hour contact numbers.

Recovery after forehead contouring

Recovery after forehead contouring is a structured process. Most patients return to desk-based work at 2 to 3 weeks, and to normal activities at 6 weeks. Final contour emerges over 3 to 6 months as swelling fully resolves and bone healing completes.

Forehead feels very tight and swollen. Scalp around the incision may feel numb. Mild to moderate headache is common. Pain typically controlled with prescribed analgesia and paracetamol. Apply cold compresses for 10 minutes every hour while awake for the first 48 hours. Sleep propped up at degrees to reduce swelling. Some patients stay one night at the clinic for monitoring.

Swelling peaks at days 2 to 4 — significant and often extending into the eyelids and occasionally cheeks. Bruising is common. Forehead numbness is normal and can extend back to the incision line. Mild headache for 3 to 5 days. Avoid bending, lifting, exertion, hot showers, saunas. Gentle face washing, avoiding the incision and forehead areas initially.

You can usually wash your hair gently from day 3, carefully around the incision. Mild shampoo, cool to lukewarm water, no hot water, no vigorous scrubbing. Hair dryer on cool setting only. Normal routines from 2 weeks.

Non-absorbable surface sutures or staples come out at 10 to 14 days. Dissolving deep sutures don’t need removal.

Swelling significantly reduces but doesn’t fully resolve. Bruising fades. Forehead numbness starts to improve. Most patients return to desk-based work at 2 to 3 weeks. Light exercise from week 3, full exercise from week 6. Scars (hidden in the hair) fade from pink to pale over the following months.

Residual swelling continues to settle. Subtle bony contour emerges but isn’t final yet. Forehead sensation continues returning (occasional tingling as nerves recover). Most patients consider themselves "recovered" at 6 to 8 weeks, though forehead tightness can persist.

The final bony contour emerges as the last residual swelling resolves. Bone healing completes over 3 to 6 months. Scalp sensation behind the incision gradually returns, though small patches of persistent numbness are common long-term (in some studies, around 10-15% of patients report some persistent numbness 1 year out).

Final result is stable. Scar matures from pink to pale. Bone setback (Type III) is permanently fixed at this point. Any subtle contour irregularities have declared themselves.

Call the clinic if you experience sudden severe headache, significant vision changes, fever, signs of infection (heat, spreading redness, pus from incision), facial swelling that worsens rather than improves, persistent nasal discharge (could indicate CSF leak — very rare but important), or anything that feels unusual. Our post-op team is available 24 hours for the first week.

Clinical review at 48 hours, suture/staple removal at days, surgeon reviews at 6 weeks, 3 months, 6 months, and 12 months.

Risks and complications of forehead contouring

Forehead contouring is a more involved procedure than soft-tissue facial cosmetic surgery and carries correspondingly greater risk. In experienced hands, serious complications are uncommon — but honest disclosure of what can go wrong is essential before making your decision. Your surgeon will discuss all risks at consultation in detail.

Centre for Surgery’s post-op team is available 24 hours a day for the first week, with same-day nurse appointments available. Complications are reviewed by the operating surgeon with onward referral where specialist input is needed. Revision surgery is available if contour or asymmetry issues arise.

How much does forehead contouring surgery cost?

Forehead contouring is a technically demanding bone procedure requiring specialist surgical expertise, longer operating times, and — in Type III cases — titanium fixation hardware. Pricing reflects this.

At Centre for Surgery:

Combined procedures in one sitting are substantially more cost-effective than staging them separately and mean a single recovery period.

Forehead contouring is a cosmetic or gender-affirming procedure and is not typically covered by private medical insurance. NHS-funded forehead contouring as part of gender-affirmation care exists but is limited to specific specialist pathways with long waiting times — we’re a private provider and don’t operate within those pathways. Patients accessing care via NHS gender identity services should discuss options with their NHS team.

Centre for Surgery is partnered with Chrysalis Finance, a specialist medical finance provider. Plans start from around £250 per month for forehead contouring, with 0% APR options available subject to status.

Full details on our , or speak to a patient coordinator on .

Why Choose Centre for Surgery for your forehead contouring

Forehead contouring is one of the most technically demanding procedures in cosmetic and facial plastic surgery. It requires specific training in craniofacial surgical principles, confident frontal sinus surgery, bony reconstruction, and the aesthetic judgement of FFS. Not every cosmetic clinic offers this procedure, and those that do vary widely in experience. Centre for Surgery’s team has dedicated experience in feminising cranioplasty and broader facial feminisation surgery.

Our surgeons are on the and include consultants with specific craniofacial training in forehead feminisation, Type III cranioplasty, and related FFS procedures. They’re members of recognised bodies including and .

We use the Ousterhout framework to match surgical approach to forehead type, rather than defaulting to a single technique. Type I (burring), Type III (anterior table setback), and less common variants all have their place — the right one depends on your specific anatomy. CT or CBCT imaging is obtained where it meaningfully changes the plan.

Forehead contouring is rarely done alone for FFS patients. Our team coordinates forehead contouring with hairline lowering, brow lift, rhinoplasty, and lower-face procedures as appropriate — sequenced for what can safely be combined and what’s best staged, based on your priorities.

Forehead contouring is transformative for the right patient — and limited, sometimes unsuitable, for the wrong patient. We’ll tell you directly if your concern is actually soft-tissue rather than bony, if your anatomy doesn’t justify the procedure, or if a different component of FFS would give you more benefit for the same investment. Our consultations are honest about what forehead contouring can and can’t change.

Centre for Surgery is fully registered and regulated by the . Our aftercare programme was rated "outstanding" — the highest rating available — with 24-hour post-op access for the first week, overnight monitoring where needed, same-day nurse appointments when needed, and extended follow-up to 12 months for forehead contouring (appropriate for a procedure where final contour emerges over 6-12 months).

Mandatory two-week cooling-off period before surgery is booked. Forehead contouring is a significant decision that deserves thorough consideration. Take the time, come back for further consultations, ask for more information. No chasing, no pressure.

For trans women and non-binary patients undergoing forehead contouring as part of FFS, our team has sustained experience working with patients at different stages of transition. We work collaboratively with your wider care team where appropriate.

Our clinic is at 95–97 Baker Street, London W1U 6RN — a short walk from Baker Street tube. Consultation, procedure, and follow-up all take place in one location. Learn more about .

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