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Brow Bone Reduction Facial Surgery: Everything You Need to Know

Medically reviewed by Jennifer Richman on May 9th, 2025.

At the Gender Confirmation Center (GCC), our surgeons offer a series of cutting-edge techniques to feminize the shape of a patient’s forehead. Specifically, many of our patients experience gender dysphoria as a result of a protruding brow bone. This is one of the many possible results of a first, testosterone-dominant puberty.  An FFS brow reduction–also called forehead feminization surgery, temple feminization, orbital bone shaving, and a frontal sinus setback– flattens the brow bone ridge, giving the forehead a flatter contour. This creates the effect of more visible, rounded eyes in addition to lifted eyebrows. Learn more about the requirements to undergo this procedure, the surgical process, costs, recovery, and more in this article. 

What Is Brow Bone Reduction Surgery?

FFS Brow reduction surgery is a procedure that permanently alters the forehead by softening and flattening an eyebrow ridge. This surgery is often performed in conjunction with orbital contouring. Together, these two procedures reduce a protruding brow bone, which creates the effect of more visible, rounded eyes and lifted eyebrows. These surgeries are also known as:

• Forehead feminization
• Forehead reduction
• Frontal sinus setback
• Brow bossing reduction surgery
• Forehead cranioplasty
• Orbital bone shaving
• Orbital bone contouring
• Orbital bone bossing
• Temple feminization

Surgical Techniques

To support patients who experience gender dysphoria related to a protruding brow bone, the following procedure options are available. Before surgery, your surgeon will order a CT scan or x-ray of the patient’s facial bones to determine which type of surgery works best. You can discuss these options in detail in a free consultation with a board-certified surgeon.

Frontal Sinus Setback Surgery

For most individuals who seek a brow bone reduction surgery, the brow bone itself is too thin to be fully shaved down, since it sits in front of a sinus cavity. In this case, the front wall of the frontal sinus can be removed, contoured, and then secured back in place using titanium or absorbable plates and screws to flatten the forehead. In medical terms, this is called a setback, alluding to the procedure name “frontal sinus setback.” 

Brow Bone Bossing Reduction Surgery

In a small number of people, about 4-5% of the population, the front wall of the frontal sinus is thick enough that it can be shaped to achieve the desired effect without being removed or “set back”. This is called frontal bone contouring. 

Orbital Bone Surgery

Our surgeons often combine brow bone reduction surgery with reshaping the supraorbital ridge (the bones of the eye socket) to help feminize the eye shape. Orbital bone contouring surgery can help make the eyes appear more open and rounded, which is more typical of the eye shape created during a first, estrogen-dominant puberty. Reshaping the orbital bones also allows for greater lifting of the brows for patients who want that done as well.

Benefits of Forehead Feminization Surgery

While some cisgender women have prominent brow ridges, this facial feature is often perceived as masculine. Given that the brow ridge is one of the most visible parts of the face, even when someone is wearing a mask, many patients are quick to notice and focus on its appearance. 

The results of a brow bone reduction become visible a few days after the initial swelling from the procedure has reduced. This makes it one of the most gratifying procedures for patients who experience relief from seeing a more contoured forehead in the mirror. 

Many of our transfeminine patients report being misgendered less after undergoing a brow reduction. While outside perceptions influence our self-esteem and self-perception,  no gender-affirming medical intervention can control the way others perceive you. Patients mustn’t undergo surgery primarily to change the reactions of others. 

Several peer-reviewed studies have shown that FFS has tremendously positive impacts on patients’ quality of life and self-esteem because of its ability to eliminate some causes of gender dysphoria. What often brings patients satisfaction, peace, confidence, and euphoria after FFS or a frontal sinus setback is seeing a face that is more aligned with their internal sense of self. 

Candidates for Brow Bone Reduction Surgery

At the Gender Confirmation Center (GCC), we only offer brow bone reduction surgery to transgender and non-binary patients. You can request a free, virtual, or in-person appointment with one of our board-certified surgeons here.

Informed Consent

Both Dr. Ley (she/her/they) and Dr. Facque (he/him) use informed consent standards to determine patient eligibility for facial surgery. In practice, this means that adult patients can decide to undergo surgery once they have been educated on the advantages and risks involved in the procedures.

Though our practice does not require therapist support letters or hormone replacement therapy (HRT) as prerequisites for FFS, many insurance providers do. For more information on obtaining a support letter from a licensed mental health professional, click here. 

Hormone Therapy

If you are currently taking estrogen HRT, we recommend that you wait 1-1.5 years on treatment before considering facial surgery. This is merely a suggestion, not a requirement. Given that HRT alters the soft tissues and overall appearance of the face, patients’ goals for surgery may differ after they see these changes. HRT will not affect bones, meaning that a protruding brow ridge will likely not lose prominence after HRT.

The Brow Reduction Procedure Explained

Step-by-Step Overview

1. Consultation and Planning: The first step to undergoing FFS is requesting a surgical consultation. At the GCC, our consultations are free of charge. During this time, you can discuss your medical history, have any questions about surgery answered, and create a surgical plan by going over your goals and expectations.
2. Pre-Operative Preparations: First, you will either receive a quote for your procedure or begin the process of soliciting pre-approval authorization from your insurance provider.
   Second, once a date for your surgery has been scheduled, you will be sent pre-operative instructions, including medical exams to do before surgery, such as a CT scan or X-ray of your skull.
3. Anesthesia Options: A frontal sinus setback is always performed under general anesthesia. This means that you will be completely unconscious for the duration of the surgery. As a result, you will need to discontinue herbal supplements and blood-thinning medications at least a week before surgery to prevent anesthesia-related complications.
4. Surgical Techniques: An FFS brow reduction is performed by first making an incision at the hairline or over the top of the scalp. The hairline incision leaves a small scar at the top of the forehead, but allows the surgeon to simultaneously perform a brow lift and hairline advancement. Since there is a sinus cavity behind the brow bone, it cannot be shaved down directly. Rather, it will be removed and contoured alongside the orbitals. It will then be set back in with titanium plates and screws, which will not set off metal detectors.
5. Duration: Performing this procedure typically takes 2–3 hours. That said, your FFS will likely last longer if you also undergo procedures like a rhinoplasty, jaw contour, and/or Adam’s Apple reduction.

Pre-Operative Instructions

• As an FFS brow reduction patient, you will need to complete an X-ray or CT scan of your cranial bones before surgery. This will allow your surgeon to have a more precise idea of the kind of contour and bone excision that needs to be made for the procedure. Our team can help GCC patients order and complete this test.
• Second, please note that you will need to stop consuming alcohol at least a week before and after surgery. Tobacco consumption and smoking of any kind should be suspended at least four weeks before and after facial surgery. Likewise, you may be asked to temporarily stop taking estradiol (estrogen hormone therapy) two weeks before FFS to reduce the risk of blood clots. You may receive other specific instructions from your surgeon.
• Third, it is important that you set up a care plan for the first week of recovery before you go under anesthesia. Please note that you will only be discharged from the hospital once you have a support person present to pick you up, since you will not be able to operate a vehicle. Likewise, you will need 24/7 care for the first 72 hours after surgery to help you ice your wounds, take medications on time, and thereby manage pain and swelling.

Complications, Risks, and Candidacy

Like any surgery, FFS carries a small risk of complications. Undergoing surgery with a qualified board-certified surgeon with hospital privileges can help ensure your safety and the integrity of your results. One of the most common long-term effects of this procedure is that patients lose a small amount of sensitivity on the scalp behind where the incision is made.

You may not be a good candidate for surgery, or may need to take some time to optimize your health if you have any of the following conditions:

• Heavy smoker, drinker, or drug user
• Uncontrolled diabetes
• Uncontrolled high blood pressure
• Bleeding or clotting disorders
• Significant lung or heart disease
• Active sinus infections
• Previous facial trauma, sinus surgeries, etc.

Please openly and honestly discuss your medical history with your surgeon to make a plan that is safe for you.

Post-Operative Recovery

Unlike other facial surgery procedures, such as jaw contouring, brow bone bossing results are often visible during the first week of recovery, making it one of the more immediately gratifying procedures for our patients. Recovery expectations can vary depending on the number of procedures performed at once, as brow bone reduction is often combined with other facial procedures. Your surgeon will provide you with specific information, and you will need to follow various recovery precautions to heal properly:

• Pain management: You will be taking prescription pain medications as needed during the first few days after surgery to manage pain. You cannot operate a vehicle or consume alcohol at this time. 
• Icing for inflammation: During the first 72 hours, you will need to place ice over the surgical sites for 20 minutes every hour. Use a towel over the ice packs or frozen vegetables to prevent ice burns. Your surgical sites will be temporarily numb while nerves regenerate, so you may not be able to feel an ice burn as it occurs. After the 72 hours, you should continue icing your face around 4 times a day for the next two weeks. 
• Sinus precautions: If you underwent frontal sinus setback, you will be on sinus precautions for the first 6 weeks after surgery. During this time, you should avoid sneezing, blowing your nose, or adding any other pressure to your sinuses. You can resolve nasal dripping by wiping your nose, not blowing it.
• Returning to work and physical activity limitations: The most difficult phase of the recovery process lasts two weeks, although patients should not lift heavy weights or engage in rigorous exercise until at least six weeks have passed. Likewise, any impact sports may need to be avoided for longer.

Aftercare Tips

• Keep the surgical site clean and follow wound care instructions. This involves placing antibiotic ointment over incisions and using cotton swabs with either hydrogen peroxide or saline water to break up any crusting here.
• You will be taking prescription pain medications during the first few days after surgery to manage pain. You cannot operate a vehicle or consume alcohol at this time.
• During the first 72 hours post-op, you will need to place ice over the surgical sites for 20 minutes every hour. Use a towel over the ice packs or frozen vegetables to prevent ice burns. Your surgical sites will be temporarily numb while nerves regenerate, so you may not be able to feel an ice burn when it comes on. After the 72 hour period, you should continue icing your face around 4 times a day for two weeks.
• You will be on sinus precautions for the first 6 weeks after surgery. During this time, you should avoid sneezing whenever possible, blowing your nose, or adding any other pressure to your sinuses. You can resolve nasal dripping by wiping your nose, not blowing it.
• You will need plenty of rest during the first two weeks and should avoid household chores or activities. Elevating your head while you rest will help manage inflammation.

The Cost of Brow Reduction Surgery

Typical Costs

It is uncommon for this procedure to be performed alone. A brow bone reduction is typically accompanied by a brow lift and/or a hairline advancement. Cash-pay patients, meaning those who are paying for surgery without insurance, can expect a quote for the upper-third of the face to come out to $10,000-$50,000. This cost estimate may not include anesthesiology or facility fees and will vary from patient-to-patient. Likewise, the costs of post-operative medications and some supplies will not be included in your surgery quote.

Financing Options

Many patients who are not able to get insurance to cover the surgery look into grants and trusted medical creditors to help them finance the procedure. We have compiled trusted resources on this page. At the GCC, all patients must pay their financial contribution in-full no later than six weeks before surgery or they risk getting their procedure cancelled.

Is brow reduction covered by insurance?

Yes, many insurance providers we work with will cover a brow bone reduction surgery for trans women and trans feminine non-binary patients. The patient will need to provide a support letter from a licensed mental health professional and be on feminizing HRT for at least a year to qualify for coverage. For more information, click here.

From the Experts:

In the following video, Dr. Facque (he/him) gives a summary of the hairline advancement and a frontal sinus setback procedures:

Frequently Asked Questions About Brow Reduction

How painful is brow reduction recovery?

A frontal sinus setback is one of the more painful procedures to recover from as it involves removing bone, contorting it, and setting it back into the skull with titanium or absorbable plates and screws. Discomfort and swelling are the most common post-operative concerns. Patients will be given prescription pain medications to manage pain for the first few days, before switching to over-the-counter medications. Most pain should subside after the first two weeks, so long as the patient does not overexert themself. 

Are the results permanent?

Yes, the results of this surgery are lifelong. While the altered bony structure of the face will be permanent, it is important to note that fluctuations in weight can alter the soft tissue composition of the face, which can make these underlying bony changes more or less visually prominent.

Will there be visible scars?

If your surgeon creates the incision for this procedure along the hairline, there will be a faint scar at the top of the forehead. Patients who are worried about visible scarring and do not want a hairline advancement can opt for the incision to be made entirely through the scalp. This way, the patient’s hair will cover the scar. Small amounts of hair loss can be expected along incision lines.

How long before I can resume work or exercise?

If your job does not require heavy lifting or other taxing physical exertion, you can return 2-4 weeks after surgery. Otherwise, you will need to wait 6 weeks to take up strenuous activities again. 

Is forehead feminization surgery covered by insurance?

Many insurance providers we work with will cover a brow bone reduction surgery for trans women and trans feminine non-binary patients. The patient will need to provide a support letter from a licensed mental health professional and likely need to be on feminizing HRT for at least a year to qualify for coverage. For more information, click here.

How much does brow bone reduction surgery cost? 

It is uncommon for this procedure to be performed alone. A brow bone reduction is typically accompanied by a brow lift and/or a hairline advancement. Cash-pay patients, meaning those who are paying for surgery without insurance, can expect a quote for the upper-third of the face to come out to $10,000-$50,000. This cost estimate may not include anesthesiology or facility fees and will vary from patient to patient. Likewise, the costs of post-operative medications and some supplies will not be included in your surgery quote.