The two distinct approaches to brow bone reduction
Patients seeking to soften prominent brow bossing — the bony ridge above the eyes — encounter two very different surgical options. The choice between them is not stylistic; it depends on the underlying anatomy.
Bone shaving (burring)
A surgical burr grinds down the front surface of the brow bone. Minimally invasive, shorter recovery, lower cost. Suitable only when the brow bone has sufficient thickness that grinding it down won\'t breach the underlying frontal sinus cavity.
Frontal sinus setback (osteotomy)
The front wall of the frontal sinus is surgically cut, removed, reshaped, and replaced in a more recessed position. Major bone reconstruction. Required for patients with significant bossing where the bone is too thin to grind without entering the sinus.
The decision is based on CT scan analysis of bone thickness, not surgeon preference or patient choice.
What is the frontal sinus?
The frontal sinus is a pair of air-filled cavities sitting behind the brow bone in most adults (some people are born without them — this matters for surgical planning). The sinus is lined with mucous membrane that drains into the nasal cavity. Surgically entering the sinus changes the procedure significantly:
- Risk of infection (sinusitis if drainage compromised)
- Requires reconstruction with plates and screws
- Longer recovery
- Higher technical demand on surgeon
- Higher cost
When frontal sinus setback is required
Indications for setback rather than burring:
- Brow bossing greater than 3–4 mm projection
- Thin bone overlying the sinus (less than 2 mm anterior wall)
- Significant supraorbital ridge prominence requiring 5+ mm reduction
- Combined with facial feminization surgery (FFS) for transgender patients
- Aesthetic correction in male patients seeking dramatic softening
- Asymmetric bossing requiring reconstruction
The procedure
- Pre-op CT imaging to map sinus anatomy and bone thickness
- 3D surgical planning with treatment template
- General anesthesia
- Incision: typically coronal (across top of scalp, hidden in hairline)
- Forehead skin reflected forward to expose brow bone
- Anterior wall of frontal sinus cut along precisely planned margins
- Bone fragment removed, reshaped, and contoured
- Sinus interior carefully preserved (drainage paths maintained)
- Bone fragment repositioned in recessed location
- Fixation with titanium miniplates and screws (1.2–1.5 mm)
- Supraorbital ridge contoured if needed
- Forehead redraped and incision closed
Total procedure: 3–5 hours. Hospital stay typically 1–2 nights.
Recovery timeline
- Day 1–3: significant swelling extending to upper eyelids; pain managed with prescribed medication
- Days 4–7: peak swelling and bruising; head elevated during sleep
- Weeks 1–2: gradual swelling resolution
- Weeks 2–4: return to office work possible (mild residual swelling)
- Month 2–3: most swelling resolved; final contour emerging
- Month 6–12: complete healing and final result
Cost in Korea (2026)
- Bone shaving (burring) alone: ₩4,500,000–7,500,000 ($3,400–5,700)
- Frontal sinus setback: ₩7,000,000–12,000,000 ($5,300–9,100)
- Combined with full FFS package: ₩25,000,000–55,000,000 total
- Combined with hairline lowering: typically +₩4,000,000–6,000,000
- International patient package: 20–30% premium for full coordination
Comparable US surgery: $12,000–25,000 for brow bone alone; $50,000–100,000 for full FFS.
Risk profile
Common temporary issues
- Forehead numbness (usually resolves at 6–12 months)
- Significant initial swelling and bruising
- Scalp tightness sensation
- Headaches (typically transient)
Less common but serious risks
- Frontal sinusitis (requires antibiotics; rarely requires revision)
- Mucocele formation in sinus (requires drainage procedure)
- Asymmetric bone reconstruction
- Persistent forehead numbness (5–10% have permanent altered sensation)
- Visible scar at coronal incision (typically hidden but variable)
- Cerebrospinal fluid leak (very rare — major complication)
Who is the right candidate?
- Significant brow bossing genuinely affecting facial appearance
- Transgender women seeking facial feminization
- Cisgender men or women with masculine brow seeking softening
- Patients with prominent supraorbital ridge contributing to "tired" look
- Adequate general health for major surgery
- Realistic expectations about recovery duration
Wrong candidates
- Mild brow projection (shaving alone sufficient)
- Significant medical comorbidities (anesthesia risk)
- Active sinusitis or chronic sinus disease
- Patients seeking minimally invasive solution
- Patients without realistic expectations about scar/recovery
- Pregnancy or breastfeeding
Combination procedures
Brow bone reduction is rarely performed in isolation. Common combinations:
- FFS package: brow bone + rhinoplasty + jaw contouring + tracheal shave
- Forehead feminization: brow bone + hairline lowering + forehead implant if needed
- Upper face refresh: brow bone + brow lift + upper blepharoplasty
- Cisgender male masculinization reversal: brow bone reduction for patients seeking softer features
How to choose your surgeon
- Verify craniofacial surgery training, not just general plastic surgery
- Confirm experience with frontal sinus setback specifically (not just burring)
- Request CT imaging review at consultation
- Ask about complication rates and revision needs
- Verify hospital affiliation for emergency management
- Confirm FFS experience if you\'re a transgender patient
Honest framing
Frontal sinus setback is real bone reconstruction — among the more technically demanding facial bone procedures. Results when done well are dramatic and permanent. Done poorly, complications can be severe and revision difficult. Choose Korean clinics with specific craniofacial expertise rather than general aesthetic clinics. The cost premium for top-tier surgeons is meaningful and worth it for this procedure — this is not where to economize. For FFS patients specifically, the procedure is typically the highest-impact single intervention for facial gender perception change. For cisgender aesthetic patients, weigh the benefit carefully against the recovery investment.