Facial Gender Confirmation Surgery: The Lower Jaw. Description of Surgical Techniques and Presentation of Results

Abstract

Background: Of the primary procedures associated with facial gender confirmation surgery, those involving the mentomandibular complex have received the least attention in the literature. Methods: The authors present their experience with 837 trans feminine patients operated on for facial gender confirmation surgery who underwent mandibular bone contouring procedures, including bone contouring, chin and mandibular body and angle ostectomies, and osteotomies to reposition the chin. The authors describe the surgical techniques and materials used, and present a customized lower border–supported cutting guide designed by their team and used with 205 patients. A femininity perception score was calculated preoperatively and 12 months postoperatively, and satisfaction with the results was measured 12 months postoperatively. Results: The postoperative follow-up ranged from 12 to 110 months. The mean femininity perception score increased from 47.86 preoperatively to 76.41 at 12 months postoperatively (p < 0.001). No emergency surgical operations were required. In no case was there any permanent damage to the mental or inferior dental nerve. The reoperation percentage because of problems detected during the postoperative period was 2.63 percent (22 patients). Conclusions: With facial gender confirmation surgery of the jawline and chin, it is possible to modify the transverse and vertical components of the jaw; soften the gonial angles; change the format, bone volume, and position of the chin; and harmonize the entire mandibular line. The facial feminization achieved high satisfaction scores regarding the results and feminine gender appearance 12 months after surgery. The future of mandibular bone contouring techniques includes planning with virtual software and surgical support with patient-specific cutting guides.

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

“…In recent years, facial GAS (FGAS) has received increased attention, and current literature supports its benefits. Eight recent publications include 1 prospective cohort (Morrison et al., 2020 ), 5 retrospective cohort (Bellinga et al., 2017 ; Capitán et al., 2014 ; Noureai et al., 2007 ; Raffaini et al., 2016 ; Simon et al., 2022 ), and 2 cross-sectional studies (Ainsworth & Spiegel, 2010 ; van de Grift, Elaut et al., 2018 ). All 8 studies clearly demonstrated individuals were very satisfied with their surgical results (between 72% and 100% of individuals).…”

Secondary Facial Gender Surgery: Causes of Poor Outcomes and Strategies for Avoidance and Correction

“…Jawline-contouring techniques include osteotomies and ostectomies at the level of the mandibular lower border, as well as bone sculpture that involves burring the surface. 5 Access to any area on the jaw must be intraoral. Likewise, we recommend the use of ultrasonic technology and a lower-border–supported cutting guide for every ostectomy and osteotomy performed.…”

“…In cases where a more extended ostectomy of the lower jaw border is needed, the use of a triple approach with basal tunneling below the mental nerves is recommended to protect them with an island of mucosa. 5 In contrast, an excessively extensive incision (mandibular degloving) exposes the nerves and risks their integrity.…”

“…30 The simplest involves eliminating the basal fragment, whether or not the chin height in the center is respected, depending on the anatomy, accompanied by bone shaving to change the format. 5 The other option is wedge resection genioplasty, eliminating the intermediate fragment and using osteosynthesis material for the fixation. 31 It is essential to be careful with periosteal stripping to prevent necrosis of the remaining fragments and eliminate any step-offs that form as a consequence of the operation.…”

“…Reports of complications in the literature are rare. [2][3][4][5] However, it is notable that the vast majority of these series come from a small handful of centers that have extensive experience with these procedures. 6 As patient demand grows and accessibility improves, the number of surgeons offering FFS procedures is increasing rapidly each year, with new surgeons simultaneously climbing their own personal learning curves.…”