Postoperative assessment of forehead contouring in facial feminization surgery

Facial feminization surgery (FFS) is essential for transgender women seeking alignment between facial appearance and gender identity. Frontal bone and sinus reshaping is a key component of FFS to achieve a more traditionally feminine contour. This retrospective study evaluates the effectiveness of frontal debossing by comparing pre- and postoperative volumetric and morphometric data. Sixteen patients who underwent frontal debossing at the University Hospital Basel between 2020 and 2024 were included. Preoperative and postoperative CT or CBCT scans were used to assess volume changes in the frontal bone, frontal sinus, and bilateral supraorbital rims. Additionally, changes in the nasofrontal angle were measured. Significant volume reductions were observed in all analyzed structures: left supraorbital rim (mean reduction 792.28 mm³), right supraorbital rim (726.19 mm³), frontal bone (2930.81 mm³), frontal sinus (2508.84 mm³), and combined frontal structures (3251.83 mm³). The nasofrontal angle increased by an average of 21.71°, indicating a substantial improvement in upper facial contour. These results support the clinical value of frontal debossing as an effective and safe component of FFS, providing quantifiable improvements in facial morphology and symmetry. This study further underscores the importance of individualized planning and objective outcome assessment in gender-affirming craniofacial surgery.