Download PDF
CC BY-NC 4.0 · Arch Plast Surg 2021; 48(05): 503-510
DOI: 10.5999/aps.2021.00199
Pediatric/Craniomaxillofacial/Head&Neck
Review Article

Evaluation and treatment of facial feminization surgery: part I. forehead, orbits, eyebrows, eyes, and nose

Brian N. Dang 
Division of Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
,
Allison C. Hu 
Division of Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
,
Anthony A. Bertrand 
Division of Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
,
Candace H. Chan 
Division of Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
,
Nirbhay S. Jain 
Division of Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
,
Miles J. Pfaff 
Division of Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
,
James C. Lee 
Division of Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
,
Justine C. Lee 
Division of Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
› Author Affiliations All sources of funds supporting the completion of this manuscript are under the auspices of the University of California Los Angeles. This work was supported by the Bernard G. Sarnat Endowment for Craniofacial Biology (JCL). JCL is additionally supported by the Jean Perkins Foundation and the National Institutes of Health/National Institute of Dental and Craniofacial Research R01 DE028098 (JCL) and R01 DE029234 (JCL). The authors thank Amanda K. Ho (NASA Jet Propulsion Laboratory, Pasadena, CA, USA) for her contributions to [Fig. 1]
› Further Information
   Permissions and Reprints

Facial feminization surgery (FFS) incorporates aesthetic and craniofacial surgical principles and techniques to feminize masculine facial features and facilitate gender transitioning. A detailed understanding of the defining male and female facial characteristics is essential for success. In this first part of a two-part series, we discuss key aspects of the general preoperative consultation that should be considered when evaluating the prospective facial feminization patient. Assessment of the forehead, orbits, hairline, eyebrows, eyes, and nose and the associated procedures, including scalp advancement, supraorbital rim reduction, setback of the anterior table of the frontal sinus, rhinoplasty, and soft tissue modifications of the upper and midface are discussed. In the second part of this series, bony manipulation of the midface, mandible, and chin, as well as soft tissue modification of the nasolabial complex and chondrolaryngoplasty are discussed. Finally, a review of the literature on patient-reported outcomes in this population following FFS is provided.

Keywords

Facial feminization surgery - Transgender persons - Gender affirming surgery - Gender dysphoria


Publication History

Received: 20 January 2021

Accepted: 12 July 2021

Article published online:
19 March 2022

© 2021. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

Comment to this article:

Commentary: Evaluation and Treatment of Facial Feminization Surgery: Part I. Forehead, Orbits, Eyebrows, Eyes, and NoseArch Plast Surg 2021; 48(05): V1-V1
DOI: 10.1055/s-0043-1777218

 

  • REFERENCES

  • 1 Lundgren KC, Koudstaal MJ. Midfacial bony remodeling. Facial Plast Surg Clin North Am 2019; 27: 221-6
    CrossrefPubMedGoogle Scholar
  • 2 Ginsberg BA, Calderon M, Seminara NM. et al. A potential role for the dermatologist in the physical transformation of transgender people: a survey of attitudes and practices within the transgender community. J Am Acad Dermatol 2016; 74: 303-8
    CrossrefPubMedGoogle Scholar
  • 3 Ainsworth TA, Spiegel JH. Quality of life of individuals with and without facial feminization surgery or gender reassignment surgery. Qual Life Res 2010; 19: 1019-24
    CrossrefPubMedGoogle Scholar
  • 4 Morrison SD, Capitan-Canadas F, Sanchez-Garcia A. et al. Prospective quality-of-life outcomes after facial feminization surgery: an international multicenter study. Plast Reconstr Surg 2020; 145: 1499-509
    CrossrefPubMedGoogle Scholar
  • 5 Fisher M, Lu SM, Chen K. et al. Facial feminization surgery changes perception of patient gender. Aesthet Surg J 2020; 40: 703-9
    CrossrefPubMedGoogle Scholar
  • 6 James S, Herman J, Rankin S. et al. The report of the 2015 U.S. transgender survey [Internet]. Center for Victim Research Repository 2016 [2020 Jun 18]. Available from: http://hdl.handle.net/20.500.11990/1299
  • 7 Pfaff MJ, Malapati SH, Su L. et al. A structured facial feminization fresh tissue surgical simulation laboratory improves trainee confidence and knowledge. Plast Reconstr Surg 2020; 145: 1016e-1017e
    CrossrefPubMedGoogle Scholar
  • 8 Morrison SD, Chong HJ, Dy GW. et al. Educational exposure to transgender patient care in plastic surgery training. Plast Reconstr Surg 2016; 138: 944-53
    CrossrefPubMedGoogle Scholar
  • 9 Coleman E, Bockting W, Botzer M. et al. Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. Int J Transgenderism 2012; 13: 165-232
    CrossrefGoogle Scholar
  • 10 Capitan L, Gutierrez Santamaria J, Simon D. et al. Facial gender confirmation surgery: a protocol for diagnosis, surgical planning, and postoperative management. Plast Reconstr Surg 2020; 145: 818e-828e
    CrossrefPubMedGoogle Scholar
  • 11 Fang F, Clapham PJ, Chung KC. A systematic review of interethnic variability in facial dimensions. Plast Reconstr Surg 2011; 127: 874-81
    CrossrefPubMedGoogle Scholar
  • 12 Hoang H, Bertrand AA, Hu AC. et al. Simplifying facial feminization surgery using virtual modeling on the female skull. Plast Reconstr Surg Glob Open 2020; 8: e2618
    CrossrefPubMedGoogle Scholar
  • 13 Mandelbaum M, Lakhiani C, Chao JW. A novel application of virtual surgical planning to facial feminization surgery. J Craniofac Surg 2019; 30: 1347-8
    CrossrefPubMedGoogle Scholar
  • 14 Pfaff MJ, Steinbacher DM. Plastic surgery applications using three-dimensional planning and computer-assisted design and manufacturing. Plast Reconstr Surg 2016; 137: 603e-616e
    CrossrefPubMedGoogle Scholar
  • 15 Ousterhout DK. Feminization of the forehead: contour changing to improve female aesthetics. Plast Reconstr Surg 1987; 79: 701-13
    CrossrefPubMedGoogle Scholar
  • 16 Habal MB. Aesthetics of feminizing the male face by craniofacial contouring of the facial bones. Aesthetic Plast Surg 1990; 14: 143-50
    CrossrefPubMedGoogle Scholar
  • 17 Somenek M. Gender-related facial surgical goals. Facial Plast Surg 2018; 34: 474-9
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Spiegel JH. Facial determinants of female gender and feminizing forehead cranioplasty. Laryngoscope 2011; 121: 250-61
    CrossrefPubMedGoogle Scholar
  • 19 Altman K. Facial feminization surgery: current state of the art. Int J Oral Maxillofac Surg 2012; 41: 885-94
    CrossrefPubMedGoogle Scholar
  • 20 Capitan L, Simon D, Meyer T. et al. Facial feminization surgery: simultaneous hair transplant during forehead reconstruction. Plast Reconstr Surg 2017; 139: 573-84
    CrossrefPubMedGoogle Scholar
  • 21 Capitan L, Simon D, Bailon C. et al. The upper third in facial gender confirmation surgery: forehead and hairline. J Craniofac Surg 2019; 30: 1393-8
    CrossrefPubMedGoogle Scholar
  • 22 Deschamps-Braly JC. Facial gender confirmation surgery: facial feminization surgery and facial masculinization surgery. Clin Plast Surg 2018; 45: 323-31
    CrossrefPubMedGoogle Scholar
  • 23 Di Maggio M. Forehead and orbital rim remodeling. Facial Plast Surg Clin North Am 2019; 27: 207-20
    CrossrefPubMedGoogle Scholar
  • 24 Ousterhout DK. Aesthetic contouring of the craniofacial skeleton. Boston: Little, Brown; 1991
    Google Scholar
  • 25 Hoenig JF. Frontal bone remodeling for gender reassignment of the male forehead: a gender-reassignment surgery. Aesthetic Plast Surg 2011; 35: 1043-9
    CrossrefPubMedGoogle Scholar
  • 26 Ousterhout DK, Zlotolow IM. Aesthetic improvement of the forehead utilizing methylmethacrylate onlay implants. Aesthetic Plast Surg 1990; 14: 281-5
    CrossrefPubMedGoogle Scholar
  • 27 Yaremchuk MJ. Facial skeletal reconstruction using porous polyethylene implants. Plast Reconstr Surg 2003; 111: 1818-27
    CrossrefPubMedGoogle Scholar
  • 28 Spiegel JH. Facial feminization for the transgender patient. J Craniofac Surg 2019; 30: 1399-402
    CrossrefPubMedGoogle Scholar
  • 29 Villepelet A, Jafari A, Baujat B. Fronto-orbital feminization technique: a surgical strategy using fronto-orbital burring with or without eggshell technique to optimize the risk/benefit ratio. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135: 353-6
    CrossrefPubMedGoogle Scholar
  • 30 Altman K. Forehead reduction and orbital contouring in facial feminization surgery for transgender females. Br J Oral Maxillofac Surg 2018; 56: 192-7
    CrossrefPubMedGoogle Scholar
  • 31 Benkhatar H, Khettab I, Sultanik P. et al. Mucocele development after endoscopic sinus surgery for nasal polyposis: a long-term analysis. Ear Nose Throat J 2018; 97: 284-94
    CrossrefPubMedGoogle Scholar
  • 32 Morrison SD, Vyas KS, Motakef S. et al. Facial feminization: systematic review of the literature. Plast Reconstr Surg 2016; 137: 1759-70
    CrossrefPubMedGoogle Scholar
  • 33 Baudouin JY, Tiberghien G. Symmetry, averageness, and feature size in the facial attractiveness of women. Acta Psychol (Amst) 2004; 117: 313-32
    CrossrefPubMedGoogle Scholar
  • 34 Gao Y, Niddam J, Noel W. et al. Comparison of aesthetic facial criteria between Caucasian and East Asian female populations: an esthetic surgeon’s perspective. Asian J Surg 2018; 41: 4-11
    CrossrefPubMedGoogle Scholar
  • 35 Scawn R, Gore S, Joshi N. Blepharoplasty basics for the dermatologist. J Cutan Aesthet Surg 2016; 9: 80-4
    CrossrefPubMedGoogle Scholar
  • 36 Cho SW, Jin HR. Feminization of the forehead in a transgender: frontal sinus reshaping combined with brow lift and hairline lowering. Aesthetic Plast Surg 2012; 36: 1207-10
    CrossrefPubMedGoogle Scholar
  • 37 Adetayo OA, Wong WW, Motakef S. et al. Endoscopic brow lift fixation with Mitek suture anchors: a 9-year experience of a new “ideal” technique. Plast Surg (Oakv) 2019; 27: 100-6
    CrossrefPubMedGoogle Scholar
  • 38 Moody BR, Weber PJ. Blepharoplasty and brow lift. In: Robinson JK, Sengelmann RD, Hanke CW. et al. Surgery of the skin: procedural dermatology. Philadelphia: Elsevier Mosby; 2005: 673-89
    Google Scholar
  • 39 Bellinga RJ, Capitan L, Simon D. et al. Technical and clinical considerations for facial feminization surgery with rhinoplasty and related procedures. JAMA Facial Plast Surg 2017; 19: 175-81
    CrossrefPubMedGoogle Scholar
  • 40 Robertson BD, Lerner BS, Collen JF. et al. The effects of transgender hormone therapy on sleep and breathing: a case series. J Clin Sleep Med 2019; 15: 1529-33
    PubMedGoogle Scholar
  • 41 Tanna N, Nguyen KT, Ghavami A. et al. Evidence-based medicine: current practices in rhinoplasty. Plast Reconstr Surg 2018; 141: 137e-151e
    CrossrefPubMedGoogle Scholar
  • 42 Berli JU, Loyo M. Gender-confirming rhinoplasty. Facial Plast Surg Clin North Am 2019; 27: 251-60
    CrossrefPubMedGoogle Scholar
  • 43 Dempf R, Eckert AW. Contouring the forehead and rhinoplasty in the feminization of the face in male-to-female transsexuals. J Craniomaxillofac Surg 2010; 38: 416-22
    CrossrefPubMedGoogle Scholar
  • 44 Deschamps-Braly JC. Approach to feminization surgery and facial masculinization surgery: aesthetic goals and principles of management. J Craniofac Surg 2019; 30: 1352-8
    CrossrefPubMedGoogle Scholar
  • 45 Noureai SA, Randhawa P, Andrews PJ. et al. The role of nasal feminization rhinoplasty in male-to-female gender reassignment. Arch Facial Plast Surg 2007; 9: 318-20
    PubMedGoogle Scholar
  • 46 Di Maggio MR, Nazar Anchorena J, Dobarro JC. Surgical management of the nose in relation with the fronto-orbital area to change and feminize the eyes’ expression. J Craniofac Surg 2019; 30: 1376-9
    CrossrefPubMedGoogle Scholar