Brow Bone Reduction in Bellevue
Forehead Feminization Surgery
Brow bone reduction — also called forehead feminization or frontal cranioplasty — is a surgical procedure that reshapes the prominent ridge of bone above the eyes to create a softer, more feminine forehead contour. For many transgender women and non-binary individuals, the brow bone is one of the most visible markers of perceived gender, making this procedure a meaningful part of their transition journey.
At Pacific Sound Plastic Surgery in Bellevue, Dr. Kristopher Day is one of the only surgeons in the Pacific Northwest with a craniofacial fellowship — the specialized advanced training required to safely reshape the bones of the skull and face. Dr. Day’s expertise in forehead bone anatomy allows him to achieve natural, feminine results while protecting the frontal sinus and surrounding structures. To schedule a consultation, call (425) 818-8991.
Double Board-Certified (ABPS + ABS)
Ivy League Trained
Highly Rated Bellevue Plastic Surgeon
Proudly Serving Bellevue, Seattle, Kirkland, Redmond, Mercer Island, Issaquah, Renton
What Is Brow Bone Reduction?
Brow bone reduction is a surgical procedure that reshapes the supraorbital rim — the bony ridge above the eye sockets — to soften the forehead’s appearance and create a more feminine facial profile. The procedure is also referred to as forehead feminization, frontal cranioplasty, or brow bossing reduction.
Understanding the Anatomy
The prominence of the brow bone is determined by the size and shape of the frontal sinus — an air-filled cavity behind the forehead bone. The extent of that sinus dictates which surgical technique will produce the best result. This is precisely why craniofacial fellowship training matters: operating near the frontal sinus and orbital rim requires intimate knowledge of skull anatomy that goes beyond standard plastic surgery training.
The Four Surgical Techniques
Type I — Bone Shaving
Best for patients with a thick frontal bone and small sinus. The outer table of bone is shaved down directly. Least invasive, no bone replacement needed.
Type II — Shaving + Bone Cement
Shaving combined with hydroxyapatite cement to fill depressions and smooth contours. Useful for subtle asymmetries.
Type III — Forehead Reconstruction
The gold standard for patients with a large frontal sinus. The anterior wall of the frontal bone is removed, reshaped, and secured back in a more feminine position. Requires craniofacial expertise.
Type IV — Reconstruction + Bone Cement
Type III technique with the addition of bone cement for an even smoother, more refined final contour.
Benefits Of a Brow Bone Reduction
Long-Lasting Results
Bone contouring produces lasting structural change — unlike fillers or non-surgical approaches that require maintenance.
Reduced Gender Dysphoria
For many patients, forehead feminization is one of the most impactful procedures in their transition journey, significantly reducing distress related to facial gender cues.
Natural Appearance
Dr. Day’s craniofacial training allows precise, anatomically appropriate reshaping — results look natural, not surgical.
Minimal Visible Scarring
The incision is placed along the hairline and becomes virtually invisible as it heals. Patients frequently report that peers cannot detect they had surgery.
Combines Well with Other Procedures
Brow bone reduction is often performed alongside a brow lift, rhinoplasty, jaw reduction, or chin surgery as part of a comprehensive FFS plan — saving recovery time.
Can Be Staged
Patients who prefer a phased approach can undergo brow bone reduction as a standalone procedure and add other FFS components later.
"Dr. Day was able to fit me in so soon for a consultation, and not a month later a surgery date! He made my experience incredibly easy and created a safe space to express what I was looking for in my procedure. Definitely would be recommending him to a ton of my friends seeking gender affirming care."
— Ryanne C., Gender-Affirming Patient • Google Review
Am I a Good Candidate for a Brow Bone Reduction?
Ideal candidates are in good overall health and have realistic expectations for what brow bone reduction can achieve. Dr. Day reviews each patient’s anatomy with CT imaging before recommending a specific technique — your forehead bone structure, frontal sinus size, and overall facial proportions all play a role in surgical planning.
- You May Be a Good Candidate If:
- You experience gender dysphoria related to your brow or forehead appearance
- You have a prominent brow ridge or heavy brow bossing
- You are in good general health with no uncontrolled medical conditions
- You are a non-smoker, or are willing to stop smoking well before surgery
- You have a letter from a mental health provider (for insurance purposes, if applicable)
- You have realistic expectations and are seeking a permanent structural change
- When to Consider Waiting
- You have active or uncontrolled medical conditions that increase surgical risk
- You smoke and are unwilling to stop — smoking impairs bone healing and increases complication risk
- You are seeking a non-surgical or temporary solution
- You are under 18 years of age (requires individual evaluation)
- You are pregnant or planning pregnancy in the near term
- You have unrealistic expectations about the degree of change possible
Not Sure If You're a Candidate?
Schedule a consultation with Dr. Day to discuss your goals and options.
Your Brow Bone Reduction Journey
Step 1 — Consultation & CT Imaging
Your consultation begins with a thorough evaluation of your goals and facial anatomy. For brow bone reduction, Dr. Day requires a pre-operative CT scan of the skull to assess frontal sinus size and bone thickness — this imaging determines which technique (Type I–IV) is right for you and ensures the safest, most precise surgical plan. Call (425) 818-8991 to schedule your consultation.
Step 2 — Surgical Planning & Documentation
If you plan to use insurance coverage, Dr. Day’s team assists with obtaining your mental health letter, pre-authorization documentation, and any supporting materials your insurer requires. Washington Apple Health (Medicaid) and many private insurers may cover brow bone reduction as part of gender-affirming care.
Step 3 — Surgery
Brow bone reduction is performed under general anesthesia. The incision is placed along the hairline (coronal approach) or within an existing hairline crease for maximum concealment. Surgery typically takes 1.5 to 3 hours depending on the technique used. Most patients having an isolated brow bone reduction are discharged the same day; patients undergoing comprehensive FFS may have an overnight hospital stay.
"I went to Dr. Day's office for facial feminization surgery, and I don't think I could be happier with the results! ... he took the time to understand my wants, but also helped me understand some of the anatomical differences between 'male' and 'female' faces and some of the surgical options we had for addressing my face."
— Michelle D., Facial Feminization Surgery Patient • Google Review
Recovery Timeline
Days 1–3
What to Expect
Low-grade activity (walking) is encouraged starting the day after surgery. Swelling peaks. Head elevation and cold compresses recommended. Most patients describe manageable discomfort rather than severe pain.
Week 1–2
What to Expect
Low-grade activity (walking) is encouraged starting Day 1. Noticeable swelling and bruising around the forehead and eyes is normal. Desk and remote work resumes by the end of Week 1. No grimace, grunt, strain, or sweat-inducing activities.
Week 2–3
What to Expect
Sutures removed (if non-dissolving). Begin gradual return to exertional activity — start at 50% of pre-operative baseline, increasing gradually each day. Light exercise achieved by end of this phase.
Weeks 4–6
What to Expect
Full return to pre-operative activity level. Unrestricted exercise including high-impact activity. Forehead contour continues to refine through month 3.
Month 1–3
What to Expect
Significant swelling resolves. Forehead contour becomes clearer. Scalp numbness along incision line is normal and gradually improves.
Month 6–12
What to Expect
Final results visible. Bone healing is complete. Residual scalp numbness (if any) continues to resolve over months.
Why Dr. Day's Craniofacial Fellowship Makes the Difference
Not all plastic surgeons are trained to operate on the bones of the skull and face. Brow bone reduction — particularly the Type III frontal cranioplasty — requires cutting, repositioning, and securing the anterior wall of the frontal sinus, which sits directly adjacent to the brain cavity and orbital rim. This is advanced craniofacial bone surgery, not soft tissue work.
Craniofacial vs. Standard Plastic Surgery Training
Dr. Day completed a fellowship in Craniofacial & Pediatric Plastic Surgery — one of the most rigorous subspecialty training programs in the field. This fellowship goes beyond standard plastic surgery residency to cover complex reconstruction of the entire skull and face. Craniofacial surgeons work regularly with the bones of the forehead, orbit, and midface — the same structures involved in brow bone reduction.
By contrast, a surgeon without craniofacial fellowship training may have limited exposure to frontal sinus anatomy, increasing the risk of inadvertent sinus entry, contour irregularities, or insufficient bone removal.
The Only Craniofacial Fellowship-Trained FFS Surgeon in Bellevue
Dr. Day is the only surgeon in the Bellevue area with both double board-certification (ABPS + ABS) and craniofacial fellowship training offering brow bone reduction and FFS. This credential is not replicable by competitors — it reflects years of specialized surgical education in the exact procedures required for safe, comprehensive forehead feminization.
Virtual Surgical Planning
For complex forehead cases, Dr. Day utilizes CT-guided virtual surgical planning — 3D imaging technology used to simulate the planned bone contour before surgery. This approach, drawn from his academic research in craniofacial reconstruction, allows for more predictable, symmetric outcomes. Dr. Day has published peer-reviewed research in 3D surgical planning techniques.
What Results Can I Expect from a Brow Bone Reduction?
Most patients report that the change in forehead appearance is one of the most transformative aspects of their transition — a softer, smoother forehead profoundly affects how the face is read and perceived by others. Results from brow bone reduction are designed to be long-lasting; the reshaped bone does not revert over time.
What to Expect from Your Results
- Flatter, smoother forehead profile from both front and side view
- Softer brow contour that no longer projects aggressively above the eyes
- A more feminine upper face that harmonizes with other features
- Minimal, well-concealed hairline scar that fades significantly over 6–12 months
- Permanent structural change — results do not require maintenanc
“My scarring is so unnoticed, people comment on how it looks like no surgery marks at all.”
— Sarah B., FFS Patient • Google Review
Brow Bone Reduction Cost in Bellevue
Brow bone reduction is considered gender-affirming care and may be covered by insurance when medically necessary for the treatment of gender dysphoria. Washington State has some of the strongest gender-affirming care coverage mandates in the nation.
What Affects Cost
- The surgical technique required (Type I–IV) — more complex Type III/IV procedures require longer operating time.
- Whether brow bone reduction is performed as a standalone procedure or combined with other FFS components.
- Anesthesia, surgical facility, and pre-operative imaging fees.
- Insurance coverage status — patients with coverage may have significantly reduced out-of-pocket costs.
Insurance Coverage in Washington
- Washington Apple Health (Medicaid) covers brow bone reduction and other FFS procedures with appropriate documentation.
- Many private insurers — including Premera, Regence, Aetna, Cigna, and Kaiser — offer coverage for gender-affirming surgical care in Washington.
- Dr. Day's team assists with pre-authorization documentation, mental health letter coordination, and insurance appeals if needed.
What’s Included in Your Investment:
- Surgeon's fee
- Facility/operating room fee
- Anesthesia (administered by a board-certified anesthesiologist or certified registered nurse anesthetist)
- Enhanced Recovery After Surgery medication (Exparel)
- Cosmetic surgery insurance coverage (Cosmetasure)
- High-end compression garment (Isavella)
- High-end scar ointment (Biocorneum)
- Swelling and bruising ointment (Arnica)
- Post-operative recovery and follow-up care
Financing Options
For patients using self-pay or whose insurance does not cover the procedure, Pacific Sound Plastic Surgery accepts CareCredit (6-month promotional financing) and Alphaeon Credit.
Contact our office at (425) 818-8991 to learn more about financing options for your specific situation.
Brow Bone Reduction
Price
Insurance may cover medically necessary cases. CareCredit and Alphaeon Credit financing available.
Full pricing is discussed at your personalized consultation.
Why Choose Dr. Kristopher Day for Your Brow Bone Reduction?
Craniofacial Fellowship Training
The only Bellevue-area surgeon with advanced craniofacial fellowship credentials for forehead and facial bone surgery — the same training used in pediatric skull reconstruction.
Double Board-Certified
American Board of Plastic Surgery (ABPS) + American Board of Surgery (ABS) — the highest standard of surgical credentialing.
Trans-Affirming Practice
Dr. Day and his team are committed to compassionate, respectful, identity-affirming care. Correct pronouns are always used. No exceptions.
Insurance Navigation Support
Our patient care coordinator and team assist with mental health letter coordination, insurance pre-authorization, and appeals — so you can focus on your journey.
Published Craniofacial Researcher
30+ peer-reviewed publications including work in 3D virtual surgical planning — the same technology applied to your forehead reconstruction.
Highly Rated Bellevue Plastic Surgeon
One of the highest-rated plastic surgeons in Bellevue, with consistent praise for surgical artistry, bedside manner, and gender-affirming care.
Conveniently Located for Eastside Families
Pacific Sound Plastic Surgery is centrally located in downtown Bellevue, making Dr. Day’s fellowship-trained expertise accessible to families throughout Bellevue and the greater Eastside — without the stress of navigating Seattle traffic. Our patients enjoy a private, boutique surgical experience with on-site validated parking, just minutes from the communities they call home.
Seattle
~15 minutes
World-class plastic surgery results without the downtown Seattle parking hassle. A quick drive across SR-520 or I-90 to our private Bellevue office.
Kirkland
~10 minutes
Just minutes from downtown Kirkland and the Juanita waterfront via I-405 or surface streets.
Redmond
~10 minutes
Convenient for the Redmond tech community via SR-520 or surface streets.
Mercer Island
~10 minutes
A quick drive across I-90. Our discreet, private environment is ideal for discerning Mercer Island residents.
Issaquah
~10 minutes
Convenient for Issaquah Highlands and Gilman Village area families via I-90.
Renton
~5 minutes
Easy access from Renton and the Landing via I-405 North. Boutique care and personalized attention just minutes away.
Frequently Asked Questions
What is the difference between Type I and Type III brow bone reduction?
Type I is a shaving technique best suited for patients with a thick frontal bone and a small or absent frontal sinus. Type III — forehead reconstruction — is required when the frontal sinus is large and close to the outer bone surface. In Type III, the anterior wall of the frontal sinus is removed, reshaped, and secured back in a more feminine position. Your CT scan determines which technique is right for your anatomy.
Is brow bone reduction covered by insurance?
It may be. In Washington State, brow bone reduction is recognized as gender-affirming care and may be covered by Washington Apple Health (Medicaid) and many private insurers including Premera, Regence, Aetna, and Cigna. Dr. Day’s office assists with pre-authorization and documentation. Call (425) 818-8991 to discuss your specific insurance situation.
What letters do I need before surgery?
Typically, one letter from a licensed mental health provider confirming your gender dysphoria diagnosis is required. For insurance purposes, additional documentation may be needed. Dr. Day’s team coordinates with your mental health provider to ensure all documentation is complete.
Where is the incision placed?
The incision is made along the hairline — a coronal approach — allowing the forehead to be accessed while keeping the scar concealed within or just behind the hairline. For patients with higher hairlines, the placement can be adjusted to avoid raising the hairline further.
How long does recovery take?
Most patients return to desk or remote work by the end of Week 1. Major swelling resolves by weeks 2–3. Light exercise resumes at weeks 2–4 using a gradual return protocol. Full unrestricted activity, including high-impact exercise, returns by weeks 4–6. Final results — including complete resolution of scalp numbness along the incision — can take several months. Bone healing is complete well before visible results are finalized.
Can brow bone reduction be combined with other FFS procedures?
Yes — and this is very common. Brow bone reduction is frequently combined with rhinoplasty, jaw reduction, chin surgery (genioplasty), brow lift, lip lift, and tracheal shave. Combining procedures reduces total recovery time and anesthesia exposure. Dr. Day creates a customized surgical plan based on your goals, anatomy, and safety considerations.
Will I still look like myself after surgery?
Yes. Dr. Day’s approach emphasizes feminizing your features while preserving your unique identity. The goal is never to create a generic look but to harmonize your facial features in a way that feels authentic to you. Your wishes guide the surgical plan.
Is brow bone reduction painful?
Discomfort rather than severe pain is how most patients describe their recovery. Pain is well-managed with prescription medication in the first few days, transitioning to over-the-counter relief by week one. Swelling and pressure sensation are the most commonly reported experiences.
Do I need to be on hormone therapy before surgery?
Not necessarily. While WPATH guidelines often include HRT as part of the gender-affirming care continuum, it is not always a requirement for brow bone reduction. Dr. Day evaluates each patient individually. Your health history and surgical goals are the primary considerations.
How do I prepare for my consultation?
Come prepared with photos that represent the forehead appearance you are hoping to achieve, as well as photos of your current profile from multiple angles. If you have existing CT imaging, bring it or provide access. Be ready to discuss your medical history, current medications, and any prior surgeries. The consultation is a conversation — there is no pressure to commit to anything.
Schedule Your Brow Bone Reduction Consultation
You deserve to feel confident in your appearance again.
Dr. Day and the Pacific Sound team create personalized transformation plans tailored to your unique goals.