Technical Pearls in Frontal and Periorbital Bone Contouring in Gender-Affirmation Surgery

Eisemann, Bradley S.; Wilson, Stelios C.; Ramly, Elie P.; Kantar, Rami S.; Alfonso, Allyson R.; Frey, Jordan D.; Bluebond-Langer, Rachel; Rodriguez, Eduardo D.

doi:10.1097/prs.0000000000007113

Cited by 13 publications

(17 citation statements)

References 10 publications

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“…The senior author's technique of frontal and periorbital bone contouring that allows for a safe and consistent surgical outcome in properly selected patients has been described in detail. 24 Our population is generally physically healthy with less than half of patients with cited mood disorders (41.6%) and HIV seropositivity (37.7%). Mood disorders may stem from a loss of patients sense of self, and are frequently comorbid in individuals suffering from gender dysphoria.…”

Section: Impressionsmentioning

confidence: 95%

“…These findings are congruent with previously published literature that suggests femininity and attractiveness are mostly attributed to the upper third of the face. 24 By addressing frontal bossing and softening the orbital shape, significant facial feminization can be achieved. The senior author's technique of frontal and periorbital bone contouring that allows for a safe and consistent surgical outcome in properly selected patients has been described in detail.…”

Section: Impressionsmentioning

confidence: 99%

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Comparative Outcomes of Partial and Full Facial Feminization Surgery: A Retrospective Cohort Study

Chaya

Boczar

Colon

et al. 2021

Journal of Craniofacial Surgery

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Background:The demand for facial feminization surgery (FFS) amongst transgender women is on the rise, and requests for a singlestage full FFS (F-FFS) are becoming more frequent. The specific aim of this article is to present our institutional experience with both partial-FFS (P-FFS) and F-FFS with a specific emphasis on safety of each approach. Methods: We examined the electronic medical record of all patients with the diagnosis of gender dysphoria that were referred to the senior author for FFS consultation at our institution, between June 2017 and October 2020. Patients were sub-grouped into those who underwent F-FFS (upper, middle, and lower facial thirds in a single anesthetic event) and those who underwent P-FFS. Univariate analysis was used to assess for difference in postoperative complications. Results: We identified 77 patients who underwent 382 total procedures. The mean follow-up time was 7.5 months (Sd ¼ 7.3) (interquartile range 1.75-12.0 months). Fifty-one (71.4%) patients underwent F-FFS and 21 (28.6%) patients underwent P-FFS. Compared to P-FFS, F-FFS was not associated with an increase in postoperative complication (1 out of 21 [4.8%] versus 4 out of 51 [7.8%]) ( P < 0.556). When comparing characteristics of patients with postoperative complications to patients with no postoperative complications, the average body mass index was significantly higher (30.9 versus 25.4, respectively). ( P < 0.029). Conclusions: Full-FFS is a set of procedures that has gained increased popularity among male-to-female transgender patients. Our results support the understanding that F-FFS is a safe and reliable approach, which may be preferable to patients and providers alike.

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Section: Impressionsmentioning

confidence: 95%

Section: Impressionsmentioning

confidence: 99%

Comparative Outcomes of Partial and Full Facial Feminization Surgery: A Retrospective Cohort Study

Chaya

Boczar

Colon

et al. 2021

Journal of Craniofacial Surgery

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“…Transillumination was used to delineate the anterior table of the frontal sinus, and then a reciprocating saw was used to create an oblique angle osteotomy. This technique prevents impaction of the posterior table, with care also taken to protect the nasofrontal outflow 21 . The bone was then secured with plates using monocortical screws.…”

Section: Case Reportmentioning

confidence: 99%

“…This technique prevents impaction of the posterior table, with care also taken to protect the nasofrontal outflow. 21 The bone was then secured with plates using monocortical screws. Contouring of the supraorbital rims and periorbital festoons was then performed.…”

Section: Stagementioning

confidence: 99%

Techniques and Trends of Facial Feminization Surgery

et al. 2022

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Background: Facial feminization surgery is composed of a variety of craniomaxillofacial surgical procedures that are increasingly sought after by male-to-female transgender patients and by those seeking feminization of the face. Facial feminization surgery can play a prominent role in alleviating gender dysphoria. In consideration of an observed increase in gender-affirming procedures performed in recent years, a broad knowledge base in the techniques, outcomes, and challenges of facial feminization surgery should be established by surgeons offering these procedures. Our review was designed to critically appraise the current literature and inform future advancements in gender-affirming surgical practice. In addition, we detail a representative case to illustrate the senior author's approach to full facial feminization. Methods: A comprehensive literature search of the PubMed, EMBASE, and Cochrane databases was conducted for studies published through June 2020 using following the search terms: "Face" OR "facial" OR "craniofacial" AND "Feminization" OR "Feminization Surgery" OR "Gender Reassignment" OR "Gender Affirming Surgery" OR "Gender Confirmation Surgery." Data on procedures, outcomes, patient age, follow-up time, complications, and patient satisfaction were collected. The data were categorized by facial thirds and then further stratified by facial feature. Results: Our search yielded 388 articles. Thirty articles fit our inclusion criteria, and of these, 23 articles were included in the review. We extracted primary data pertaining to 3554 patients with an age range of 18 to 73 who underwent 8506 total procedures. Most of the procedures addressed the upper facial third (hairline, forehead, and brow), comprising 49.1% of total procedures performed. Further categorization by facial feature revealed that the most commonly addressed feature was the forehead (34.6% of procedures), followed by the nose (12.8%) and the chin (12.2%). In studies that used quantitative measures to gauge patient-reported outcomes, satisfaction was high. Conclusions: Facial feminization surgery seems to be safe, whether it is conducted in a single stage or as a staged procedure. Patients report high satisfaction and better gender congruency after facial feminization procedures. Further research is needed to establish best surgical practice and gauge patient satisfaction beyond the length of average follow-up and determine the frequency with which adjunctive procedures are sought out.

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“…Part II reviews techniques for lips, midface, mandible, chin and laryngeal prominence. Eisemann et al [16] give a detailed description of the techniques used by the senior author for frontal and periorbital bone contouring. Louis et al [17] describe their algorithmic approach to recontouring the forehead and upper third of the face.…”

Section: Techniquesmentioning

confidence: 99%

Developments in facial feminization surgery

Rodman¹

2022

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of review Facial feminization surgery (FFS) is being performed by facial plastic surgeons with increasing frequency. As insurance companies expand benefits to cover these procedures, more and more institutions are developing programs to treat transgender patients. The purpose of this review is to summarize recent literature on the subject so that those interested in this subject may have a framework to analyze these works. Recent findings The most significant findings are that FFS does appear to be safe with low complication rates, despite long operative times due to multiple procedures performed. Much of the recent literature is reviews of each practice's techniques. This is valuable to educate those interested in beginning to perform these surgeries. Further, these reviews can eventually be compiled into a standard of care. Virtual surgical planning is currently being used by some departments, but its value is yet to be determined. Summary FFS is performed with increasing frequency. Current literature reviews best practices with the goal of eventually establishing a standard of care.

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Technical Pearls in Frontal and Periorbital Bone Contouring in Gender-Affirmation Surgery

Cited by 13 publications

References 10 publications

Comparative Outcomes of Partial and Full Facial Feminization Surgery: A Retrospective Cohort Study

Comparative Outcomes of Partial and Full Facial Feminization Surgery: A Retrospective Cohort Study

Techniques and Trends of Facial Feminization Surgery

Developments in facial feminization surgery

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