In this guide16 sections
- Key Points
- Where Is the Brow Bone?
- Why Is My Brow Bone So Prominent?
- Can You Reduce Your Brow Bone Without Surgery?
- How Does Brow Bone Reduction Surgery Work?
- Who Is Suitable for Brow Bone Reduction?
- Is Brow Bone Reduction Safe? Risks and Complications
- How Painful Is Brow Bone Reduction?
- Brow Bone Reduction Recovery: How Long Does It Take?
- What Do Brow Bone Reduction Results Look Like?
- How Much Does Brow Bone Reduction Cost in the UK?
- Brow Bone Reduction, Brow Lift or Hairline Lowering: Which Do You Need?
- How Do I Choose a Brow Bone Reduction Surgeon?
- Frequently Asked Questions
- Brow Bone Reduction in London
- References
Key Points
- Can you reduce a prominent brow bone? Yes, but only with surgery. The brow ridge is bone, so exercise, massage, make-up and fillers cannot make it smaller. Brow bone reduction (forehead contouring) either burrs the bone down or sets back the front wall of the frontal sinus.
- Why is my brow bone so prominent? Usually inherited bone shape plus the effect of puberty hormones. Testosterone increases how far the brow ridge projects[1]. Injury and, rarely, a bone-growth condition can also be responsible.
- Two main techniques: burring the bone down when it is thick, and a setback of the front wall of the frontal sinus, which averages around 4 mm in published series and is the approach most patients need[4].
- Safety: a systematic review of 673 patients found a pooled complication rate of 1.3%, and careful CT planning is what keeps the risk low.
- Recovery: most people go home the same day, return to desk work at two to three weeks, resume normal activity at around six weeks and see the final contour at three to six months.
- Check it is the bone: a low brow, a high hairline or heavy eyelids can mimic a heavy brow bone and each needs a different operation.
A strong brow ridge is one of the most noticeable features of the upper face, and many people search for how to reduce a prominent brow bone after years of hiding it with a fringe, glasses or make-up. This guide explains what the brow bone is, why it can be prominent, what does and does not work, and how brow bone reduction surgery is performed. At Centre for Surgery the operation is offered as forehead contouring surgery, most often as part of facial feminisation surgery (FFS).
Brow bone reduction reshapes bone; it does not change the height of your forehead or the position of your eyebrows. If your forehead looks too tall rather than too heavy, our guide to a big forehead and the hairline lowering page explain that different problem, and if your brows sit low rather than forward, a brow lift is the operation to look at. Sorting out which of these you have is the first job of a consultation.
Where Is the Brow Bone?
The brow bone is the horizontal ridge of the frontal bone that runs above your eye sockets, just beneath the eyebrows. Doctors call it the supraorbital ridge or brow ridge, and a pronounced one is described as brow bossing or frontal bossing. Behind the ridge sits the frontal sinus, an air-filled space inside the forehead bone, and the front wall of that sinus is surprisingly thin: around 3 mm on average in a CT study of 50 patients considering forehead feminisation[3].
That anatomy explains why a prominent brow bone cannot be treated like a soft-tissue concern. The prominence is bone, and it often contains a hollow space, so any operation has to respect the sinus.
Why Is My Brow Bone So Prominent?
The shape of the brow ridge is set mainly by genes and by puberty. Testosterone drives growth of the upper face, flattening the central forehead and increasing the forward projection of the brow bone and the rims of the eye sockets[1]. That is why a heavy brow ridge is more common in men, and why it is one of the clearest cues the eye uses to read a face as masculine. Plenty of women inherit a strong brow ridge as well, and for some it is the one feature they would change. Our guide to facial feminisation surgery for cisgender women covers that situation.
A brow can also look more prominent than the bone really is. Low-set eyebrows, deep-set eyes and a flat forehead all exaggerate the shadow under the ridge, a pattern often described as hunter eyes, and a poorly proportioned profile can make the brow look heavy even when the bone is average, as our article on the perfect side profile explains.
What causes frontal bossing in adults?
In most adults it is simply normal variation in skull shape. Less often, an old injury leaves the ridge uneven. Rarely, a condition that changes bone growth, such as acromegaly, can enlarge the brow ridge over the years. If your brow, hands, feet or jaw have visibly changed in adulthood, or you have new headaches or vision changes, see your GP rather than a surgeon first.
When does the brow bone stop growing?
The brow ridge develops through puberty and the facial skeleton is largely mature by early adulthood. Bone continues to remodel slowly throughout life, but a brow ridge that keeps enlarging in adulthood is not typical and is worth a medical check. Surgery is only considered once the facial skeleton has matured, and we do not operate on anyone under 18.
Can You Reduce Your Brow Bone Without Surgery?
No treatment applied to the skin or the muscles can shrink bone.
Do face exercises or massage reduce a brow bone?
No. Facial exercises train muscle and massage moves fluid. Neither removes bone, and there is no evidence that either changes the shape of the brow ridge.
Do fillers or injections reduce a prominent brow bone?
No. Dermal filler adds volume; it cannot take bone away. Anti-wrinkle injections can soften forehead lines and fillers can alter the shadows around the brow, but they change the surroundings, not the ridge itself. Neither is a way to make a prominent brow bone smaller, and an honest consultation will tell you so.
How can you make your brow bone look less prominent?
- Hair: a soft fringe or side-swept style hides the ridge completely.
- Glasses: frames with a heavier top line draw attention away from the brow.
- Brows and make-up: a softer, slightly higher arch and blended contouring on the ridge reduce its shadow.
- A brow lift, if your brows are low: raising the eyebrows can open the eye area and makes the ridge look less dominant, although it does not change the bone. Our guide to droopy eyebrows explains how to tell, and eyebrow lifts without surgery covers what non-surgical options can and cannot do.
How Does Brow Bone Reduction Surgery Work?
Brow bone reduction, also called forehead contouring, forehead reduction of the bone, brow ridge reduction or forehead feminisation, reshapes the frontal bone so the forehead curves smoothly into the brow. At Centre for Surgery it is performed under TIVA (total intravenous anaesthesia) and takes about two to four hours on its own, longer when it is combined with other facial procedures. Most people go home the same day.
The surgeon reaches the bone through a coronal incision, which runs across the top of the scalp from ear to ear and usually sits within the hair, or through an incision along the hairline when hairline lowering is being done at the same time. The scalp is lifted forward, the nerves that supply the forehead are protected, and the bone is reshaped using the technique that suits your anatomy. The framework that guides that choice was first described by Ousterhout in 1987[2] and is still used today.
Type I brow bone reduction: burring the bone
When the bone is thick and there is little or no sinus behind the prominence, the surgeon can shave the ridge down with a surgical burr. The sinus is not entered, and no plates are needed. This is the simplest version of the operation but suits only a minority of people.
Type III brow bone reduction: setting back the front wall of the frontal sinus
When the sinus extends into the prominent area, the front wall is too thin to burr down without breaking through. The surgeon cuts out the front wall of the sinus in one piece, reshapes it, sets it back and fixes it with small titanium plates and screws. In a series of 123 patients, 94.5% needed this approach, and the front wall of the sinus was set back by an average of 4.2 mm, against 2.7 mm for the intermediate group treated by burring and rebuilding[4]. A few millimetres sounds small, but it is the difference between a forehead that projects forward and one that curves smoothly.
Intermediate foreheads and building up a flat brow
Some foreheads fall between the two. Where the bone is moderately thick or the sinus is shallow, a full setback would over-recess the forehead, so the bone is recontouted and the sinus wall rebuilt with a graft from the skull[4]. An under-projected forehead can instead be built up with bone cement, a custom implant or fat grafting, and published reviews describe endoscopic and custom-implant approaches for mild defects[5]. Your surgeon will explain which suits you.
Is 3D planning used for brow bone reduction?
A CT or cone-beam scan shows how thick the front wall is and how deep the sinus runs, which is what decides the technique. At Centre for Surgery, your plan can include 3D surgical modelling and patient-specific cutting guides, produced with specialist partner companies and included in your quote. In one published series of 16 patients using cutting guides, there were no complications and satisfaction with the forehead and brows was very high[6].
Who Is Suitable for Brow Bone Reduction?
You are likely to be suitable if you have a visibly prominent brow ridge, in good general health, with realistic expectations. Brow bone reduction is most often performed for trans women and non-binary patients as part of FFS, and it is also an option for cisgender women with a naturally strong ridge and for people whose brow has been left uneven by an injury. Our guide to hormone therapy before facial feminisation surgery answers a question that often comes up beforehand.
A consultation will also look at:
- Whether it is bone at all. Heavy eyelids, low brows or a high hairline can all create a similar look.
- Your sinuses. Tell the team about chronic sinusitis, previous sinus surgery, migraines or earlier forehead surgery.
- Smoking. You will need to stop smoking and vaping, including nicotine replacement, for four weeks before and four weeks after surgery.
- Expectations. On its own, forehead contouring produces a more limited change than when it is combined with hairline lowering or a brow lift as part of a plan.
You must be at least 18, and anyone with unresolved frontal sinus disease or a bleeding disorder is not a candidate until that is addressed.
Is Brow Bone Reduction Safe? Risks and Complications
Serious complications are uncommon. A 2020 systematic review of 673 patients ↗ published in Aesthetic Plastic Surgery found a pooled complication rate of 1.3%, and complications seldom needed another operation[7]. Outcome measures were not standardised between studies, so treat any single percentage with caution.
The most common worry is the frontal sinus. In a 2021 follow-up study of patients for up to eight years ↗ published in Facial Plastic Surgery & Aesthetic Medicine, sinus and headache symptoms were no worse in patients whose sinus lining had been entered during surgery than in those where it had been preserved[8].
Common effects after brow bone reduction
- Swelling and bruising that can spread into the eyelids and cheeks
- Forehead and scalp numbness, which usually improves over 6 to 12 months
- Headache for three to five days
- Itching and tingling as the nerves recover
- Temporary thinning of hair near the incision
- Small firm bumps where plates or screws sit
Uncommon and rare risks
Uncommon risks include wound infection, a collection of blood under the scalp (haematoma), a visible scar where hair is thin, numbness lasting beyond a year and small bumps or hollows in the bone contour that sometimes need a minor revision. Rarely, the sinus can cause problems after a Type III setback, including a mucus-filled cyst or infection of the surrounding bone. One published case report described frontal osteomyelitis and sinusitis after this operation, which needed further surgery[9]. A leak of fluid from around the brain and injury to the nerve that moves the forehead are very rare.
You can lower your risk by choosing a surgeon who regularly performs forehead surgery, stopping nicotine, telling the team about sinus history and attending every follow-up appointment. If something does not feel right, you have a direct contact number for your surgical team.
How Painful Is Brow Bone Reduction?
You are asleep under TIVA during surgery. Afterwards most people describe the forehead as tight, swollen and numb rather than very painful, with a mild to moderate headache for three to five days that prescribed pain relief and paracetamol usually control. Cold compresses for the first 48 hours and sleeping propped up at 30 to 45 degrees reduce swelling, and pain generally settles within a week, although tightness and altered sensation take longer. Reviews of forehead contouring describe the operation as well tolerated overall[5].
Brow Bone Reduction Recovery: How Long Does It Take?
Recovery follows a predictable pattern, and planning for it makes it easier. The timings below match what we advise on the forehead contouring page, and your surgeon will tailor them to your operation.
- First 48 hours: a tight, swollen forehead, cold compresses every hour while awake and sleeping with your head raised.
- Days 2 to 4: swelling peaks and bruising can extend into the eyelids. Wear loose button-front tops and avoid pulling clothes over your head for two weeks.
- 10 to 14 days: stitches or staples are removed.
- Two to three weeks: most people return to desk-based work. Light cardio can restart at around two weeks.
- Three to four weeks: running and weights can resume gradually, with heavy lifting at about six weeks and contact sports not before three months.
- Six weeks: most normal activities resume and your surgeon reviews your progress.
- Three to six months: the final contour appears as the last swelling settles and the bone finishes healing.
Follow-up continues at three, six and twelve months because the contour and the scar keep maturing. If you are also having a brow lift, our guide to brow lift recovery covers the shared aftercare.
What Do Brow Bone Reduction Results Look Like?
The change is often subtle from the front and much clearer in profile, because the side-on shape of the forehead is what changes. In a 2025 study of 16 patients using CT scans ↗ published in the Journal of Cranio-Maxillofacial Surgery, the angle where the forehead meets the nose opened by an average of about 22 degrees after forehead contouring, and the volume of the brow ridges and frontal bone fell measurably[10]. Patients typically notice that the eyes look less deep-set and the brow curves more softly into the nose.
The photographs below show one of our patients before and after facial feminisation surgery that included forehead contouring.
The bone change is permanent, because the bone heals in its new position, although soft tissue continues to age as normal. A well-planned result should look natural rather than flattened. Many more results are on our facial feminisation surgery page.
How Much Does Brow Bone Reduction Cost in the UK?
The cost of brow bone reduction in the UK depends on your forehead type, on what else is done in the same operation and on whether it is a first operation or a revision. Combining procedures usually costs less than staging them separately and gives you one recovery.
At Centre for Surgery, forehead contouring is quoted individually at consultation and confirmed in writing, so you know exactly what your quote covers. When you compare quotes from other clinics, check whether each includes CT imaging, 3D planning, plates and screws, follow-up appointments and the anaesthetist. Our finance options let you spread the cost, subject to status.
Can you get brow bone reduction on the NHS?
Not for cosmetic reasons. Facial feminisation procedures, including forehead contouring, are not routinely funded by the NHS, and private medical insurers do not usually cover them. If you are under an NHS gender identity service, talk to your NHS team about your options as well.
Brow Bone Reduction, Brow Lift or Hairline Lowering: Which Do You Need?
People search for “forehead reduction surgery” and “brow reduction” for several different problems, and the right operation depends on which one you have.
- The bone sticks out: brow bone reduction. Our forehead contouring page covers the operation in detail.
- The forehead is tall: hairline lowering moves the hairline forward. Our guides to hairline lowering scars and to forehead reduction with a receding hairline explain what to expect.
- The brows sit low: a brow lift repositions them. The article on brow lift vs blepharoplasty helps if you are unsure whether the problem is the brow or the eyelid.
- The eyelid skin hangs: blepharoplasty (eyelid surgery) removes the excess.
- There is a hard lump on the forehead: this may be an osteoma rather than a prominent brow. Read about how to tell if a forehead lump is an osteoma and forehead osteoma removal.
Many people have more than one of these, so upper-face surgery is usually planned as a whole. Brow bone reduction is often combined with hairline lowering and a brow lift through the same incision, and sometimes with rhinoplasty, since setting the brow back opens the angle at the top of the nose. Lower-face work such as chin surgery or a tracheal shave is usually staged separately. Our guides to combining facial procedures and non-binary surgery explain how plans are shaped around your goals.
How Do I Choose a Brow Bone Reduction Surgeon?
Brow bone reduction combines bone work, safe handling of the frontal sinus and aesthetic judgement, so experience matters. In a Polish review of 20 patients having upper-face feminisation, most of those treated elsewhere had come because the original operation had not reduced the brow bone enough, often because a simple burring technique had been used where a full setback was needed[11]. Ask any surgeon:
- Are you on the GMC Specialist Register ↗?
- How many forehead operations do you perform, and how do you decide between burring and a setback?
- Will you use CT imaging and 3D planning?
- Will the surgeon who assesses me be the surgeon who operates?
At Centre for Surgery, forehead contouring is performed by GMC-registered surgeons at our CQC-regulated Baker Street hospital, and the surgeon who assesses you at consultation is the surgeon who performs your surgery. We recommend a two-week cooling-off period after consent, because this is a significant decision that deserves time.
Frequently Asked Questions
Can you reduce your brow bone without surgery?
No. A prominent brow ridge is bone, and no exercise, massage, make-up, filler or injection can make it smaller. Only surgery that burrs the bone down or sets back the front wall of the frontal sinus reduces it. Hair, glasses and brow shaping can disguise it.
How long does brow bone reduction surgery take?
About two to four hours on its own. It takes longer when combined with hairline lowering, a brow lift or other facial feminisation procedures. Most people go home the same day with a responsible adult, and overnight nursing can be arranged if you are staying locally.
What are the downsides of forehead reduction surgery?
Expect two to three weeks off desk work, swelling and bruising that can reach the eyelids, and forehead numbness that may take 6 to 12 months to improve. There is a small scar in the hair, and uncommon risks include infection, haematoma, contour irregularities and, rarely, sinus problems. The contour takes three to six months to settle.
How much does brow bone reduction cost in the UK?
It is quoted individually at consultation, because the cost depends on your forehead type and on which other procedures you combine. A Type III setback is a longer operation than burring alone. Your written quote shows what is included, and finance is available subject to status.
Can I get a forehead reduction on the NHS?
Not for cosmetic reasons. Facial feminisation procedures, including forehead contouring, are not routinely funded, and private insurers do not usually cover them. If you are under an NHS gender identity service, discuss your options with that team.
Is a forehead reduction worth it?
It can be, when the bone is genuinely the concern. The operation produces a permanent change in the contour and often a clear improvement in profile, but on its own the change is more limited than when combined with hairline or brow surgery. A consultation will tell you honestly whether it is worth it for you.
Brow Bone Reduction in London
If a prominent brow bone is bothering you, a consultation with a surgeon will establish whether it is the bone, the brow position or the hairline, and which technique would suit your anatomy. Find out more about forehead contouring surgery at Centre for Surgery.
Phone: 020 7993 4849 | Address: 95–97 Baker Street, Marylebone, London W1U 6RN
Contact us to schedule a consultation
References
- Rolfes B. Brow bossing reduction. Otolaryngologic Clinics of North America 2022;55(4):785–795. doi:10.1016/j.otc.2022.04.003 ↗
- Ousterhout DK. Feminization of the forehead: contour changing to improve female aesthetics. Plastic and Reconstructive Surgery 1987;79(5):701–713. doi:10.1097/00006534-198705000-00003 ↗
- Schmidt M, Ramelli E, Atlan M, Cristofari S. Frontal sinus anatomical scanographic study of transgender patients for feminization frontoorbitoplasty surgery. Annales de Chirurgie Plastique Esthétique 2023;68(2):93–98. doi:10.1016/j.anplas.2023.01.001 ↗
- Moghadam S, Shariati K, Huang KX, et al. The Type I+ forehead in facial feminization surgery. Aesthetic Plastic Surgery 2024;48(23):4778–4783. doi:10.1007/s00266-024-04341-2 ↗
- Gupta N, Clark C. Forehead contouring. Facial Plastic Surgery Clinics of North America 2023;31(3):363–370. doi:10.1016/j.fsc.2023.03.003 ↗
- Ganry L, Cömert M. Low-cost and simple frontal sinus surgical cutting guide modeling for anterior cranioplasty in facial feminization surgery: how to do it. Journal of Craniofacial Surgery 2022;33(1):e84–e87. doi:10.1097/SCS.0000000000008064 ↗
- Eggerstedt M, Hong YS, Wakefield CJ, Westrick J, Smith RM, Revenaugh PC. Setbacks in forehead feminization cranioplasty: a systematic review of complications and patient-reported outcomes. Aesthetic Plastic Surgery 2020;44(3):743–749. doi:10.1007/s00266-020-01664-8 ↗
- Basa K, Lee A, Shehan JN, et al. Frontal bone cranioplasty for facial feminization: long-term follow-up of postoperative sinonasal symptoms. Facial Plastic Surgery & Aesthetic Medicine 2021;26(6):e813–e817. doi:10.1089/fpsam.2021.0037 ↗
- Brown AE, Shrout MA, Howard BE. Frontal osteomyelitis and sinusitis complication after Type III frontal bone cranioplasty for facial feminization. Facial Plastic Surgery & Aesthetic Medicine 2023;26(1):79–82. doi:10.1089/fpsam.2022.0397 ↗
- Abazi S, Schatzmann T, Beyer M, et al. Postoperative assessment of forehead contouring in facial feminization surgery. Journal of Cranio-Maxillofacial Surgery 2025;53(11):1966–1973. doi:10.1016/j.jcms.2025.08.014 ↗
- Pokrowiecki R, Šufliarsky B, Jagielak M. Feminization surgery of the upper face as the crucial factor in gender confirmation: pearls and pitfalls. Medicina (Kaunas) 2024;60(1):120. doi:10.3390/medicina60010120 ↗
