Original ArticlesThe Upper Third in Facial Gender Confirmation Surgery Forehead and HairlineCapitán, Luis MD, PhD; Simon, Daniel DMD; Bailón, Carlos MD; Bellinga, Raúl J. MD, FEBOMS; Gutiérrez-Santamaría, Javier MD, FEBOMS; Tenório, Thiago MD; Capitán-Cañadas, Fermín PhDAuthor Information FACIALTEAM Surgical Group, HC Marbella International Hospital, Marbella, Málaga, Spain. Address correspondence and reprint requests to Luis Capitán, MD, PhD, FACIALTEAM Surgical Group, HC Marbella International Hospital, Ventura del Mar 11, 29660 Marbella, Málaga, Spain; E-mail: firstname.lastname@example.org Received 29 March, 2019 Accepted 18 April, 2019 The authors report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jcraniofacialsurgery.com). Journal of Craniofacial Surgery: July/August 2019 - Volume 30 - Issue 5 - p 1393-1398 doi: 10.1097/SCS.0000000000005640 Buy SDC Metrics Abstract The upper third of the face contains 2 features that are particularly important for facial gender recognition: the frontonasoorbital region and the hairline. The supraorbital ridge, which determines the position and exposure of the eyebrows, is almost invariably more developed in the male than in the female. Surgical modification of the frontonasoorbital complex, considered a standard procedure in facial feminization, is reliable and predictable, and also delivers satisfactory results that are stable over time. A prototypical male hairline has an M-shaped pattern compared to the more rounded shape often seen in female hairlines. Feminization of the hairline requires minimizing the temples as well as rounding out the overall shape, optimizing hair density, and occasionally changing the height of the hairline. This article provides an update on our forehead reconstruction technique and our experience in the treatment of hairline redefinition. © 2019 by Mutaz B. Habal, MD.