Forehead & Orbital Remodeling

There are two important differences between the anatomy of the skull in a man and in a woman. Forehead shape in a woman is flat, uniform & rounded. The distance between the eyebrow and the hairline is shorter than the one in a man and describes an arch. Forehead in a man has the typical brown bossing with a pronounced brow convexity, because of the major development of the orbital rim and frontal sinuses. Finally the masculine hairline describes the typical “M” shape.

Description of the MDM´s forehead & orbital remodeling surgery

The remodeling of the forehead & orbital bone is the most important part of the Facial Features Remodeling Surgery (FFRS) or Facial Feminization Surgery (FFS). We use the typical craniofacial approach, a bicoronal incision, at the front of the hairline, or across the hair, if you don’t want or do not need to advance your hairline and don´t need to change your “M” shape hairline.
Most of the patients need the hairline incision to do the forehead & orbital remodeling, the correction of the “M” hairline and to do the eyebrow lift with the same approach. It is very important to understand that the hairline advance could achieve 1,5 cm and never more than 2 cm, so in several cases you will need to have a posterior hair transplant done to completely resolve the hairline place and shape problem.
In some cases, shaving the brow ridge is enough to obtain a forehead reshape, but in about 95% of the cases, a reconstruction of the external wall of the frontal sinuses is necessary (see below Forehead reconstruction or shaving? What type of forehead remodeling?)
In 95% of the difficult forehead cases, MDM prefers to do a complete bone & orbital remodeling with osteotomy and reconstruction.
Only 5 % of all MDM´s patients, during the last 10 years had the unusual type I Ousterhoud classification. Also in this kind of forehead, MDM does an osteotomy and not a shaving, later he decides whether to use the bone or not.
Below you can read in detail the frontal sinus osteotomy and forehead reconstruction, but first we would like to highlight an important MDM famous approach to design the most popular MDM´s orbital results to obtain “the change in the expression of the eyes, giving softness, delicacy, youth & beauty.” Because of the osteotomies and remodeling that MDM does at the orbital rim, you will see the difference between your result and others if you decide to have your surgery done with MDM & Team. The reason why most of the best result you can find in the web with osteotomy & reconstruction is the one we are doing, is because with the shaving of the frontal bone at the wall sinus level it is impossible to reduce the bossing more that a mm, and you cannot have the option to reposition the health & solid bone, because you directly lose your bone or reduce the bone quality with the grinding of the electric saw. Finally, MDM uses the shaving to do the last details of the forehead reconstruction. Those x-rays show the typical case with brow bossing and medium size frontal sinus(,….that required a Forehead & Orbital Osteotomies & Remodeling.)

Many patients and surgeons try to see the secret that MDM uses at the frontal bone & frontal sinus to obtain the best result of the world at the forehead and orbital remodeling…MDM removes the external wall of the frontal bone, including the external wall of the frontal sinus and part of the superior orbital rim. Then we remodel the shape and size of the bone, and with the rest of the bone we produce “bone chips” and “bone paste” to use at the end of the reconstruction. Now it is time to see the frontal sinus… There are several types of frontal sinus and also different kinds of ducts, big or small, deep or superficial, extended or delimited. In most cases, (now 90 %) MDM does the reconstruction respecting the anatomy and function of sinus. In most cases the sinus mucosa is removed, but at the same time without compromising the ducts and function. In a lower percentage, (10%) when the sinus is small, delimited, superficial and with a small duct, we prefer to treat the sinus completely and remove the total of the sinus mucosa, place bone chips and bone paste, and obliterate the sinus.

Many patients and surgeons try to see the secret that MDM uses at the frontal bone & frontal sinus to obtain the best result of the world at the forehead and orbital remodeling…MDM removes the external wall of the frontal bone, including the external wall of the frontal sinus and part of the superior orbital rim. Then we remodel the shape and size of the bone, and with the rest of the bone we produce “bone chips” and “bone paste” to use at the end of the reconstruction. Now it is time to see the frontal sinus… There are several types of frontal sinus and also different kinds of ducts, big or small, deep or superficial, extended or delimited. In most cases, (now 90 %) MDM does the reconstruction respecting the anatomy and function of sinus. In most cases the sinus mucosa is removed, but at the same time without compromising the ducts and function. In a lower percentage, (10%) when the sinus is small, delimited, superficial and with a small duct, we prefer to treat the sinus completely and remove the total of the sinus mucosa, place bone chips and bone paste, and obliterate the sinus. In some cases we use “bone chips” placed into the sinus osteotomy to support the new remodeled frontal wall. They are remains of the forehead reduction and are used to give support to the anterior wall when it is put back in place. This way the grafted wall gets propped from inside by these pieces of bone and without the need to use titanium screws, plates or mesh to keep it stable. Finally MDM uses some “bone paste” to fill the gaps and irregularities.
With the MDM forehead reconstruction surgery, we can set back as close to the ideal female range as needed. We have some other details but we can share them with you in person, for most of the artists have their secrets.
Another important difference between MDM results and other surgeons’ is the quality of the work in the orbital rim. MDM does a lot of different osteotomies and shaving to remodeling not only the supraorbital bone, but also the superior and external orbital wall, changing the height and the diameters of the orbits giving them anatomically female values. This work is reflected in the uniqueness of MDM´s patients’ results, mainly in the change of the “expression of the eyes, giving softness, delicacy, youth & beauty”. Last important point to clarify is MDM includes the frontonasal area at the forehead remodeling because he thinks it is really important to do your rhinoplasty at the forehead step in most of the cases.

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