Note it says
"Sex: O" likely for other because insane troon kekeke.
Also holy jawbones and sinus cavity.
So some explanation on frontal sinus cavity and his brow bone.
'
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Rioley sagittal view kek. So look at the sinus hole area aka black space in front of brain He has REALLY thin bone structure so he wont' be able to get the "easy method" which is just burring away the bones. about 20% of cases may only need this or some minor shaving beyond. So giving his giga sinus he will actually need the most complicated form of surgery for brow ridge which is called Cranioplasty type 3 which is very complex,
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As you can see in this pic the sagittal view this scrote has a larger bone protrusion that can be shaved as opposed to Ripples. Basically what they do is like this they have to CAREFULLY reposition the a piece of bone back without disrupting the sinus cavity and then use metal screws to bolt it in place and some bone filler gel made from your own bones to fill the gaps.
oh and the surgery procedure kind of looks like this when it's being done. Very horror movie-esque kek.
What he REALLY needs
besides therapy and meds likely is like a lefort double or triple jaw surgery to get rid of his long ass face (mid face surgery, they reposition basically the area above your teeth or shave some off and also shave off/reposition lower jaw and sometimes the chin too for troons). Granted these are Korean women but you get my drift
Also this is much less intensive than a full jaw like a lip lift where they make an incision under the nose and lift the lip to create a shorter philtrum. This one is really good for a way better pass. Here's an example on some transes, still not cute but way way less creepy: