A more authentic reflection begins at the top
The forehead, brow region, and hairline—often called the upper third of the face—are among the most gender-defining areas of facial anatomy. These features can shape how you’re perceived in the world, and just as importantly, how you recognize yourself in the mirror.
On this page:
» What Is Upper Third Facial Feminization Surgery (FFS)?
» Who Can Benefit from Facial Feminization Surgery (FFS)?
» A Surgeon’s Eye: Upper Third Anatomy
» Masculine vs. Feminine Forehead Differences
» Surgical Approaches
» Choosing Your Incision
» Brow Bone Reduction & Your Anatomy Types
» Frontal Sinus Reconstruction: Step-by-Step
» Supraorbital Rim Contouring
» Brow Lift Options
» Advanced Technology
» What to Expect After Surgery
» Questions to Ask Your Surgeon
» Upper Third FFS FAQs & Recovery Guidance
At Evolve Your Life in Chicago, we understand how personal Feminine Facilitation Surgery (FFS) can be. Dr. Amir Dorafshar brings a craniofacial-informed approach to facial feminization—pairing careful planning with artistry and empathy—so your results feel natural, balanced, and aligned with your identity.
Because the upper third involves both appearance and complex anatomy (including the frontal sinus), this is an area where surgical judgment and experience truly matter.
What Is Upper Third Facial Feminization?
Upper third facial feminization surgery focuses on reshaping the forehead, brows, and hairline to create a smoother, softer, more feminine appearance. Depending on your goals and anatomy, surgery may involve:
- Lowering or reshaping the hairline
- Lifting the brows
- Modifying the forehead and brow bone to smooth prominent contours
- Softening the orbital rims (upper eye socket margins) to create a more open, feminine look
These changes are designed to work together. It’s not about “changing everything.” It’s about building harmony—so the upper third blends naturally with the rest of your face and feels like your true reflection.
Who Can Benefit from Upper Third Feminization Surgery (FFS)?
Upper third feminization is most common among transgender women and nonbinary individuals seeking gender-affirming procedures. It can also benefit anyone who feels their forehead, brow ridge, or hairline contributes to a more masculine appearance than they desire.
You may be a good candidate if you relate to any of the following:
- A high or receding (“M-shaped”) hairline
- A strong or prominent brow ridge
- A tall forehead or sharp angle between the forehead and nose
- A desire for smoother, rounder, more balanced upper facial features
A Surgeon’s Eye: Upper Third Anatomy
Our approach at Evolve Your Life starts with understanding your anatomy—because the upper third isn’t just surface contour. It’s hair-bearing scalp, brow position, bone thickness, sinus structure, and the way light falls around the eyes.
Hairline
The hairline defines the upper border of the forehead. Shape and position are major gender cues—often more “M-shaped” with temple recession in cisgender masculine patterns, and typically lower and rounded in cisgender feminine patterns.
Eyebrows
Masculine-pattern brows tend to be flatter and sit directly on the ridge above the eyes. Feminine-pattern brows typically sit higher (about 1 cm above the ridge) and arch naturally.
Forehead contour
Masculine-pattern foreheads are often taller, more sloped, and may have a pronounced brow ridge. Feminine-pattern foreheads tend to be shorter, smoother, and more gently curved.
Frontal sinus (brow bone)
The bony region above the eyes influences brow projection. Its thickness and shape help determine what contouring is possible and which approach is safest.
Orbital rims
The upper edges of the eye sockets can be softened to reduce shadowing and create a more open, feminine look.
Masculine vs. Feminine Forehead Differences
The forehead plays a major role in how masculine or feminine a face appears. Understanding these differences helps explain why upper third feminization can be so transformative.
Typical cisgender masculine forehead features
- Taller forehead: often 6–8 cm from hairline to eyebrows
- M-shaped hairline: “widow’s peak” pattern with recession at the temples
- Flat, low eyebrows: sit right on the brow bone
- Prominent brow bone: can create a “heavy” or deep-set appearance
- Sharp angle: where forehead meets the nose
Typical cisgender feminine forehead features
- Shorter, more proportionate forehead height
- Rounded hairline without receding temple areas
- Arched eyebrows: curved shape, sitting ~1 cm above the brow bone
- Smooth forehead: less prominent brow bone for softer contours
- Gentle angle: smoother transition from forehead to nose
Surgical Approaches to Forehead Feminization
Upper third feminization often addresses several areas at once: lowering the hairline, reducing brow bone prominence, lifting/reshaping the eyebrows, smoothing the forehead, and improving overall proportion.
If you’re someone who wants every detail, we’re with you. Below is a comprehensive overview of the most common approaches. We’ll help you decide what’s right for you, guided by Dr. Dorafshar’s principles: Choose what fits your anatomy and your goals, nothing more, nothing less.
Choosing Your Incision
Incision placement is one of the most important decisions because it affects what can be accomplished and where the scar will heal.
Option 1:
Coronal Incision (Behind the Hairline)
Where it goes: typically 3-5 inches behind your current hairline, hidden in your hair
Best for: Patients who already have a good hairline shape and position
Advantages:
- Completely hidden scar
- Excellent access for brow bone work
Limitations:
- Cannot move your hairline forward
- Cannot fix an M-shaped hairline
Option 2:
Pretrichial Incision (At the Hairline)
Where it goes: Right along your existing hairline
Best for: Patients who want to lower their hairline or fix an M-shaped pattern
Advantages:
- Can advance hairline forward 1.5-2.5 cm
- Fixes cis-masculine hairline shapes
- Addresses multiple concerns in one surgery
Considerations:
- Scar is along the hairline (but usually heals very well)
- Requires careful surgical technique
- Perfect for comprehensive facial feminization
How your incision is chosen
Your surgeon recommends an approach based on hairline shape/height, how much brow bone reduction is needed, your goals, and hair thickness/growth patterns.
Brow Bone Reduction & Your Anatomy Types
The brow bone (frontal sinus region) is often the most masculinizing feature of the forehead. That’s why planning is so important here. Dr. Dorafshar typically uses CT imaging to understand your unique bone structure and sinus anatomy, then selects the safest technique to achieve the feminine contour you want.
Four Types of Brow Bone Anatomy
Type 1: Thick Bone, Small Sinuses
What this means: thick, solid bone with minimal air spaces
Treatment: direct shaving/contouring
What to expect: carefully sculpting to create feminine contours
Type 2: Mild Prominence, Thin Bone
What this means: Some projection, but the bone is thin.
Treatment: conservative shaving plus smoothing with bone cement
Why this approach: helps prevent entering sinus spaces
Result: smoother contours with minimal structural changes
Type 3: Prominent Brow Bone, Thick Bone (Most Common)
What this means: significant projection with adequate bone thickness
Treatment: complete frontal sinus reconstruction
Why it works: enables dramatic feminization while maintaining safety and stability
Type 4: Flat Brow Bone
What this means: insufficient brow definition (less common)
Treatment: building up rather than reducing
Approach: strategic augmentation to create proper feminine brow shape
The Frontal Sinus Reconstruction:
Step-by-Step
When significant reduction is needed, frontal sinus reconstruction may be recommended. This approach allows major contour changes while protecting the underlying sinus space.
Step 1: Accessing the Area
The brow bone is reached through the chosen incision and carefully exposed.
Step 2: Removing the Bone Section
The outer layer of bone is cut and removed in one piece—similar to lifting off the front panel of a box.
Step 3: Reshaping
That bone segment is reshaped outside the body using specialized tools to soften angles and create feminine curvature.
Step 4: Managing the Sinus Space
The air space behind the bone is cleaned and may be filled with your own tissue if needed.
Step 5: Replacing and Securing
The reshaped bone is positioned and secured with small titanium plates and screws designed to remain in place permanently.
Supraorbital Rim Contouring
In addition to brow bone reduction, the supraorbital rims (upper eye socket margins) can be contoured to:
- Reduce the shadowing effect that makes eyes look deep-set.
- Create a more open, bright-eyed, feminine appearance.
- Smooth transitions between the forehead and eye sockets.
This step is often performed with brow bone reduction for the most dramatic orbital opening effect.
Advanced Technology
Some surgical plans incorporate:
- 3D computer planning to create a precise surgical roadmap
- Custom guides to support accuracy during surgery
When paired with craniofacial-level anatomical understanding, these tools help translate your goals into a plan that’s both artistic and exact.
Brow Lift Options
Drooping brows (brow ptosis) can make the upper face appear heavy, tired, or more traditionally masculine. Brow lift techniques elevate and reshape the brows, improving upper eyelid visibility and restoring a softer, more feminine arch.
Options may include:
- Direct Brow Lift: Incision just above the brows, rarely used due to visible scar.
- Endoscopic Brow Lift: Small incisions behind hairline, using a camera to elevate brows and secure them higher-minimal scars, natural results.
- Hair Line Brow Lift: A pre-trichial or incision just in front of the hair bearing region of the scalp can be performed to hide the scar, lift the brow and provides opportunity to advance the hair bearing scalp forwards to shorten the non hair bearing portion of the forehead.
- Coronal Brow Lift: Performed through a coronal incision which is ideal when combined with forehead contouring or hairline lowering.
Brow lift improves upper eyelid visibility, restores a youthful arch, and creates a brighter, more feminine look.
What to Expect
Upper third feminization is meaningful surgery—and healing is a process.
Healing Timeline
- First week: Swelling and bruising peak
- 2-4 weeks: Most swelling subsides
- 3-6 months: Tissues settle and soften
- 6-12 months: Final results become apparent
Scar Healing
- Coronal scars: Usually invisible once hair grows back
- Pretrichial scars: Heal along the hairline and become very subtle over time
- Scar care: Your surgeon will provide specific instructions for optimal healing
Important Considerations
- This is major surgery requiring significant healing time
- Multiple aspects of your upper face are addressed simultaneously
- Results are permanent and can be truly life-changing
- Recovery requires patience as swelling resolves gradually
Questions to Ask Your Surgeon
The right plan is the one that fits you. Consider asking:
- Which incision approach do you recommend for my goals?
- What type of brow bone anatomy do I have?
- How much hairline advancement can I expect?
- What will my scars look like long-term?
- How long before I see my final results?
- What are the risks specific to my case?
About Dr. Dorafshar
Dr. Amir Dorafshar is a board-certified plastic, aesthetic, and reconstructive surgeon, renowned worldwide for his pioneering work in aesthetic surgery, craniofacial and microsurgical reconstruction, facial gender-affirming surgeries, and computer-assisted surgical techniques.
With over three decades of professional experience, Dr. Dorafshar’s commitment to medical innovation and his passion for advancing surgical practices have established him as a leading expert, respected author, and authoritative figure in the field.
From Our Patients
At Evolve Your Life, we’re committed to delivering a world-class experience through attentive, responsive, and compassionate care. How are we doing?
See what some of our patients have to say:
Kiersten Obermayer
Dr. Dorafshar is absolutely amazing. He truly cares about the results as well as the patient. He checked up on me multiple times through my recovery and my results are amazing already after 10 days! Can’t wait to see them when I’m fully healed!
Khyla Tatak
Talk about a great experience overall. Dr. Dorafshar made me feel at ease, answered all of my questions and set realistic expectations on recovery. Constantly checked in to make sure I was doing ok during the first week post surgery. His team set the bar high. I’m so incredibly happy with my results.
“Anyone seeking out a great surgeon who will work with your needs and help you feel like the best version of yourself, I highly recommend Dr. Amir Dorafshar.”
—Iliana Diana
See yourself. Be yourself.
At Evolve Your Life, we know how important it is to look in the mirror every day and see a reflection that feels like your own.
