The figures below show an example of the aggressive brow-bone
reconstruction work often done by Dr. Ousterhout as just one
part of the overall Facial Feminization Surgery (FFS) on transsexual
These figures [from Aesthetic Contouring of the Craniofacial
Skeleton, Douglas K. Ousterhout, Ed., 1991] show how a large
section of forehead anterior to the sinuses can be removed, sectioned,
recontoured and then wired back in place to feminize the forehead
and browridge. This is the "Forehead III" procedure,
which Dr. Ousterhout performs on patients who have prominent
browridges not thick enough in front of the sinuses to allow
reduction by grinding alone. Adequate grinding in such cases
would make the forehead too thin in front of the sinuses. Lynn
required this Forehead III procedure, and the result dramatically
feminized her profile.
Some patients brow/forehead reductions can be fully and more
easily done using the "Forehead II" procedure, in which
the contouring can be accomplished via grinding followed by some
filling-in with a surgical "bondo" called methyl methacrylate
to eliminate any adjacent concave regions. Other cases ("Forehead
I" cases) can be fully accomplished even more easily using
grinding alone. The FFS operation time is affected by the type
of forehead surgery required for the patient. Surgical costs
are lower for type I and II vs type III. The decision on which
procedure to use (and many others) is made during the earlier
examination of the patient's facial X-rays.
Cutting out the anterior wall
of the frontal sinuses, sectioning into pieces, and wiring them
in place after sinus margins (right) have been contoured.
Anterior wall of frontal sinus after being removed
and prior to being sectioned into pieces and recontoured.