Can You Combine Forehead Contouring with a Coronal Brow Lift?

Publication date: 5/2026

You can combine forehead contouring with a coronal brow lift, and in most facial feminization cases it’s strongly recommended. Forehead contouring and a coronal brow lift are designed to be performed together. They share the same incision, the same anesthesia, the same recovery, and they correct two related features that almost always should be addressed at the same time. Doing one without the other can leave the upper face looking incomplete or, in some cases, off-balance.

This article walks through how the combination works, who’s a good candidate, what the recovery looks like when both are done in one operation, and the situations where we’d recommend separating them. If you’d like to see how this combined approach has worked for previous patients, our forehead feminization gallery shows before-and-after results from cases that included brow bone reduction, orbital rim contouring, and a coronal brow lift performed together.

What Forehead Contouring and a Coronal Brow Lift Each Do

Forehead contouring (also called brow bone reduction or frontal cranioplasty) addresses the bony structure of the upper face. In patients who went through puberty with increased testosterone levels, the frontal bone tends to develop a forward-projecting ridge above the eyes called brow bossing, along with a more sloped forehead and prominent orbital rims. Reducing this bone is one of the most powerful steps in feminizing the face. The two techniques most commonly used are a type 1 cranioplasty (burring the bone down) and a type 3 cranioplasty (cutting, reshaping, and resetting the anterior wall of the frontal sinus). Which one is right depends on how thick the bone is and how large the frontal sinus is. You can read more about the specific techniques on the brow bone reduction surgery page.

The reason these two procedures get talked about together is that the cisgender masculine brow tends to sit at or below the bony brow ridge, while the cisgender feminine brow tends to sit above the supraorbital ridge with a softer arch, peaking around 1 cm above the ridge.¹ When you reduce the brow bone without lifting the brow, the soft tissue often settles in a position that doesn’t match the new bony framework. When you lift the brow without reducing the bone, you’re elevating the brow over a heavy ridge that still reads as masculine. The two procedures correct two halves of the same problem.

Why the Coronal Incision Makes Combination So Practical 

The coronal incision is what makes combining these procedures efficient rather than additive. To perform a type 1 or type 3 cranioplasty, we need full surgical access to the entire frontal bone, the orbital rims, and the area just above the brows. The coronal incision provides exactly that exposure. Once that incision is open and the forehead flap is reflected forward, performing a brow lift requires no additional incision and only a modest amount of additional time at the end of the operation. The brow lift becomes a step at the end of the procedure rather than a second surgery.

Because of this, forehead contouring in facial feminization is almost always performed concurrently with a brow lift through the same coronal or pretrichial (hairline) incision. It’s the standard approach, not the exception. Plastic surgeons perform a slight brow lift in nearly every brow bone reduction case anyway, because the soft tissue needs to be re-suspended in a natural position after the bone has been reshaped. Without that step, the brows can settle lower than they were before surgery, which is the opposite of what most patients want.

The coronal scar itself is one of the better-tolerated incisions in facial surgery. Because it sits within the hair, it heals into a fine line that’s usually very well hidden and, with longer hair, can be extremely difficult to see. For patients who don’t need their hairline lowered, this incision is preferred over a pretrichial (hairline) incision precisely because the scar essentially disappears.

Recovery When Both Are Done Together

One of the practical advantages of the combined approach is that recovery isn’t significantly longer than recovery from forehead contouring alone. The brow lift adds a small amount of swelling and a slightly longer initial healing window, but the bulk of the recovery is driven by the bone work and the coronal incision, which would be there either way.

In the first week, expect swelling around the forehead and eyes. Pain is typically easily managed with oral pain medications, and many patients describe the discomfort as more of a tightness or pressure than sharp pain. Many patients develop temporary forehead numbness from the supraorbital nerves being stretched during the procedure, and this numbness, while sometimes startling, actually reduces the amount of pain experienced in the first week.

Most patients return to desk work and light activities around 10 to 14 days, though the most visible swelling fades even sooner. The brow position itself looks artificially high in the first few weeks. As the healing continues, the brows settle into their final position, and what you see at the six-month mark is essentially the surgical result, with normal aging continuing from there.

Strenuous exercise, heavy lifting, and anything that increases blood pressure to the head should be avoided for about four to six weeks. Sleeping with your head elevated for the first week helps reduce swelling. Dr. Paul Mittermiller typically sees patients back at 7-10 days, 1-2 months, 4-6 months, and then 1 year for postoperative checks.

Risks of the Combined Procedure

Combining multiple FFS procedures can increase surgical risk in certain specific scenarios. However, combining forehead contouring with a brow lift doesn’t significantly increase risk compared to doing the bone work alone. The brow lift step uses tissue that’s already been mobilized for the bone work, so it doesn’t add new tissue trauma or a new surgical field. The risks that exist apply to the procedure as a whole rather than to either component individually.

Two sets of nerves run through the surgical field. The supraorbital and supratrochlear nerves provide sensation to the forehead and front of the scalp. Most patients experience some degree of forehead numbness immediately after surgery from these nerves being stretched during the procedure, and sensation typically recovers over weeks to months. Sometimes the recovery can take months to years. In a small number of patients, the numbness can be permanent. The temporal branch of the facial nerve, which provides motor function to the muscles that raise the eyebrows, runs in the temporal region near the lateral edge of the surgical field. Injury to this nerve is uncommon but can result in weakness of the forehead muscle on the affected side. Similar to postoperative sensory abnormalities, motor irregularities usually recover within weeks to months, though they can take months to years, and are rarely permanent. There’s also a possibility of asymmetry in the brow position after healing, which is most often mild and adjusts on its own during recovery but can occasionally require revision.

Bleeding, infection, hematoma, and unfavorable scarring are standard risks of any surgical procedure under general anesthesia. With careful surgical technique and good post-operative care, these are uncommon but not zero.

Cost

When forehead contouring and a coronal brow lift are performed at the same time through the same incision, the combined cost is meaningfully less than performing them as two separate operations. You’re paying for one operating room session, one anesthesia team, and one recovery, rather than two of each. For patients planning multiple FFS procedures, combining these two is usually the most efficient option.

Frequently Asked Questions

Will my brows look natural after the combined procedure?

This is the most common concern, and the answer is that brow position is something Dr. Paul Mittermiller plans carefully. The goal is a brow that sits softly above the orbital rim with a gentle arch, not a high or surprised look. In the first few weeks, the brows are higher than where they will eventually settle. By three to six months, the brows are in their final position, and the result is meant to look like a face that simply has feminine bone structure, not one that has undergone surgery.

Can I have a brow lift later if I only do forehead contouring now?

Yes, but it’s almost always better to do both at the same time. Going back through a coronal scar later is a more complicated operation than performing the brow lift during the original surgery, and the second procedure adds another anesthesia session, another recovery, and additional cost. Dr. Paul Mittermiller would recommend this approach only if there’s a specific medical reason to separate the two.

Will the coronal scar be visible?

For most patients, no. The incision is placed several centimeters behind the hairline within the hair-bearing scalp, and once healed, it’s difficult to see even with the hair pulled back. There can be a small area of thinning right along the scar, which usually grows in over time. Patients with very short hair or visible scalp tend to be more aware of the scar than patients with longer hair.

Considering Combined Forehead Surgery in Los Angeles

Combining forehead contouring with a coronal brow lift is one of the most reliable, well-established techniques in facial feminization surgery, and for most patients it produces a more harmonious result than doing either procedure alone. The decision about whether to combine them, and which specific bone-reduction technique to use, depends on your anatomy, your goals, and what other procedures you may be planning. If you’re considering forehead feminization and want to discuss whether the combined approach is right for you, we’d be glad to walk you through your options. You can contact our office to schedule a consultation.

Citations

1. Dang BN, Hu AC, Bertrand AA, Chan CH, Jain NS, Miles Pfaff, James Lee, Justine Lee (2021) Evaluation and treatment of facial feminization surgery: part I. forehead, orbits, eyebrows, eyes, and nose. Arch Plast Surg 48 (5):503–510. doi:10.5999/aps.2021.00199 https://pmc.ncbi.nlm.nih.gov/articles/PMC8490104/