Facial Gender Confirmation Surgery Article Reviews

Surgical Management of the Nose in Relation with the Fronto-Orbital Area to Change and Feminize the Eyes' Expression

This article describes the authors experience with Facial Feminization Surgery. Reduction Rhinoplasty is significant component of facial feminization surgery. The male nose, compared to the female counterpart, generally has a more acute nasofrontal (between the nose and forehead) and nasolabial (between the nose and upper lip) angles. Additionally, the male face generally has a greater degree of prominence at the supraorbital area (bone below the eyebrows). Feminization of the nose is often performed in conjunction with other feminization procedures. The authors separate these into two separate procedures; the first targeted at the lower third of the face and the second targeted at the midface and upper third. The reduction rhinoplasty, which often consists of taking down the nasal dorsum (top of the nose), osteotomies (fractures) to narrow the nose, and tip refinement to de-project the nose and lift the tip.  Softening of the nasofrontal angle (between nose and forehead) is performed in with reduction of the prominence of the bone below the eyebrows through an incision in the hair. This article explains these procedures as well as the authors experience in performing them. The authors discuss the importance of setting appropriate expectations prior to surgery. Read the full article here: Surgical Management of the Nose in Relation with the Fronto-Orbital Area

The Upper Third in facial Gender Confirmation Surgery: Forehead and Hairline 

The most common surgical procedure in the literature for Facial Gender Confirmation Surgery (FGCS) is forehead recontouring/reconstruction. The upper third of the face contains two 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 generally more developed in men than women. Men also typically have a a M shaped hairline, whereas women have a rounded hairline. This article provides an update on the authors’ forehead reconstruction technique in addition to techniques to make the hairline appear more feminine. A total of 1049 trans female patients were treated with forehead reconstruction between the 122 months of August 2008 and September 2018. 287 patients of the total number (27.36%) underwent simultaneous hairline transplant (SHT), 77 patients (7.34%) hairline lowering surgery (HLS), and 22 patients (2.09%) deferred hair transplant (DHT). Pre-operative and postoperative tele radiography, cephalometric studies, photographic imaging and 3D photography were performed. To feminize the forehead, the author’s used a modified coronal approach. The author’s opened the frontonasal angle, achieved an adequate backward position of the entire forehead, maintained a rounded shape, and recontoured the superior orbit. With simultaneous hair transplant, the author’s harvest hair follicles from the strip of scalp obtained during the modified coronal approach and grafted them after completing the forehead reconstruction. Regarding side effects od forehead reconstruction, most patients described parethesias of the scalp an forehead which resolved around three months after the procedure. The most common complication associated with the hair follicle rich grafts were scabbing in the recipient site (which was correlated wth seborrheic dermatitis), folliculitis or bleeding. Read the full article here: The Upper Third in Facial Gender Confirmation Surgery

Additional articles of interest:

One-step Facial Feminization Surgery
Approach to Feminization Surgery and facial Masculinization Surgery
Feminization of Transgender Women with Thyroid Chondroplasty and Laryngoplasty