Orbital Rim Contouring for Facial Feminization – Los Angeles

Orbital rim contouring is a key component of forehead feminization and facial feminization that seeks to further remove masculine features and feminize the forehead. This surgery can be performed for cisgender, transgender (MTF), and gender non-binary or non-conforming individuals.

The term orbital rim describes the ridge of bone that surrounds the eyeball. When talking about orbital rim shaving, this usually specifically refers to the upper, outer part of the orbit. In men, this bone is typically more pronounced. In women, this ridge is much softer, less pronounced, and rounder. Orbital rim contouring aims to soften this masculine feature and further enhance one’s feminine features.

Dr. Mittermiller is one of only a few surgeons in California and the states with specialty training in craniofacial surgery and facial feminization surgery.

Introduction

What is orbital rim contouring surgery?

Orbital rim contouring surgery is typically performed as part of forehead feminization, which is a subset of facial feminization. Although it technically includes the frontal bone (or brow bone) and is sometimes an extension of the brow ridge, it is often discussed separately from brow bone reduction. Brow bone reduction is most commonly performed as a type 1 reduction. or type 3 reduction. The frontal sinuses do not extend to the upper, outer orbital rim, so contouring is usually sufficient for achieving a dramatic result.

Orbital rim contouring involves shaving the bone located underneath the tails of the eyebrows or cutting the bone in this region. This opens the eyes allows more light to fall on them.

Why is orbital rim shaving performed?

Orbital rim shaving is performed for cisgender women to increase feminine appearance and for transgender women, gender non-binary individuals, and gender non-conforming individuals to relieve symptoms of gender dysphoria. The procedure reduces the masculine appearance of the face by softening the bones around the eyes.

Surgery

How is orbital rim contouring performed?

Orbital rim contouring can be performed using a variety of techniques.^{1 2 3} The most common technique is to create an incision either across the top of the head (coronal incision) or through a hairline incision. A hairline incision is used for patients who are simultaneously undergoing a hairline lowering (aka scalp advancement) procedure. The coronal incision is used when there are no modifications being done to the hairline.

In some cases, an upper eyelid incision can be used. This is not as frequently performed because this incision can not be used to reduce the bone at the center portion of the forehead. Most patients who are undergoing orbital rim contouring are also undergoing a formal brow bone reduction (reduction of bone at the central forehead).

Once the orbital rim bone is accessed, a combination of tools are used to shave the bone and make it less prominent.

What are the risks of orbital rim reduction?

There are multiple nerves that provide sensation and motion to the forehead. The nerves that supply motion to the forehead pass near the orbital rims. It is possible for these nerves to be injured during the orbital rim reduction operation, resulting in weakness on one or both sides of the forehead. Most patients will have some degree of weakness immediately following orbital rim reduction that recovers over the following weeks to months. In some patients, the weakness can be permanent.

Before and after photographs of orbital rim contouring

It is important to review the work of any surgeon before you undergo a procedure with them. This allows you to see the before after results that are regularly obtainable and the results you can expect or anticipate. The photographs allow you to see the location and degree of scaring that can result after orbital rim reduction. Many surgeons have styles of results that they attempt to obtain. Before after photographs of orbital contouring allow people to see the preferred style of each surgeon.

You can review Dr. Mittermiller’s FFS photo gallery or see a few example photographs below of typical orbital rim contouring before after photos.

Frequently Asked Questions

Prior to Consultation

Am I a candidate for orbital rim contouring?

Orbital rim contouring is offered for cisgender, transgender (MTF), and and gender nonbinary or nonconforming individuals who are seeking to feminize their face. It can be the correct choice for people who are hoping to soften the masculine features around the eyes and enhance one’s natural feminine features.

Candidacy for surgery depends on multiple variables. One may not be an ideal candidate if they have medical problems that can result in significant complications from anesthesia.

Insurance companies sometimes cover facial feminization for the treatment of gender dysphoria, which results when there is an incongruence between one’s physical traits and one’s gender identity.

Can cisgender women undergo orbital rim shaving?

Yes, cisgender women can get orbital rim shaving.

Recovery

Are there scars after orbital rim contouring?

The scars associated with orbital rim contouring are related to the location of the incisions. A coronal incision (an incision that goes over the top of the head) is usually very well hidden within the hair. A hairline incision does leave a visible scar that can be slightly hidden with the adjacent hair. The scars from incisions in the upper eyelid are difficult to see from a conversational distance.

How is recovery from orbital rim shaving? Is it painful?

Orbital rim shaving is usually not very painful. When performed with other facial feminization procedures, it is usually not a source of primary concern. When a scalp incision is used to access the orbital rims, there will be swelling of the forehead that can persist for a few months postoperatively. When an eyelid incision is used, the upper eyelid and orbital rim region will remain swollen for a few weeks following surgery. The eyelid incisions can take a couple months to completely heal and become less visible.

References

1. Marcelo Di Maggio (2019) Forehead and Orbital Rim Remodeling. Facial Plast Surg Clin North Am 27 (2):207-220. doi:10.1016/j.fsc.2019.01.007 https://pubmed.ncbi.nlm.nih.gov/30940386/
2. Dang BN, Hu AC, Bertrand AA, Chan CH, Jain NS, Pfaff MJ, Lee JC, 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://pubmed.ncbi.nlm.nih.gov/34583435/
3. Luis Capitan, Daniel Simon, Kaye K, Tenorio T (2014) Facial feminization surgery: the forehead. Surgical techniques and analysis of results. Plast Reconstr Surg 134 (4):609-619. doi:10.1097/PRS.0000000000000545 https://pubmed.ncbi.nlm.nih.gov/24945951/