Narrative review of facial gender surgery: approaches and techniques for the frontal sinus and upper third of the face - PubMed (original) (raw)
Review
Narrative review of facial gender surgery: approaches and techniques for the frontal sinus and upper third of the face
Matthew Louis et al. Ann Transl Med. 2021 Apr.
Abstract
Facial gender confirmation surgery (FGCS) is a series of procedures which seek to harmonize a patient's face with his/her self-image and gender identity. Originally described in San Francisco in the 1980s, FGCS has evolved to encompass all elements of the craniofacial skeleton and facial soft tissue. This field in plastic and reconstructive surgery has quickly gained more attention in the past decade due to the pioneering work of groups around the world along with increased social acceptance and medical care of the transgender community. This narrative review focuses on the upper third of the face. Key differences in the forehead and the hairline of cis men and women are discussed which inform pharmacologic and surgical interventions. Hairline modifying therapies including pharmacotherapy and hair transplantation are explained. Virtual surgical planning (VSP), a tool broadly used in surgical fields, has a special role in FGCS and we offer advice in using VSP when addressing the frontal sinus. Use of VSP allows the surgeon to provide reproducible and accurate results. We then discuss the history of the frontal sinus setback and offer our algorithmic approach to recontouring the forehead with detailed description of the operative steps and decision making. Finally, postoperative care and complications considered.
Keywords: Facial feminization; frontal sinus setback; gender affirmation surgery.
2021 Annals of Translational Medicine. All rights reserved.
Conflict of interest statement
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm-20-6432). The series “Transgender Surgery” was commissioned by the editorial office without any funding or sponsorship. Dr. Louis reports grants from DePuy Synthes Trauma/Craniomaxillofacial Research Fellowship Program, during the conduct of the study. The authors have no other conflicts of interest to declare.
Figures
Figure 1
Frontal, lateral views of pre-operative virtual surgical planning for feminization of the forehead. The cutting guide, designed in VSP sessions, reduces the amount of time required to perform the osteotomy and decreases risk of intracranial violation.
Figure 2
Intraoperative views. Left: pericranial flap is raised and cutting guide is situated over the frontal sinus. Middle: bone flap over frontal sinus after osteotomy. Right: bone flap after burring and fixation with miniplates in a more inferior, posteriorly rotated position.
Figure 3
Top panel: pre-operative photos of a patient who underwent forehead feminization with a frontal sinus setback and burring of the frontal bone. Bottom panel: one-month post-operative photos demonstrating reduced frontal bossing and creation of a feminine, convex forehead.
References
- Deschamps-Braly J. Facial Gender Affirmation Surgery: Facial Feminization Surgery and Facial Masculinization Surgery. In: Schechter LS, editor. Gender Confirmation Surgery: Principles and Techniques for an Emerging Field [Internet]. Cham: Springer International Publishing; 2020 [cited 2020 Mar 31]. p. 99–113. Available online: https://doi.org/ 10.1007/978-3-030-29093-1_12 -DOI
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