Facial Feminization Surgery Research Articles

Estrogen hormone therapy stabilizes lateral hairline in transfeminine patients: Implications for facial feminization surgery

BackgroundAlthough many studies report on the suppressing effects of estrogen therapy on facial and body hair in transgender and nonbinary (TGNB) individuals, few studies have elucidated its effects on hairline stability on the scalp. In this work, we assessed the influence of estrogen therapy on forehead length. MethodsAll TGNB patients assigned male at birth (AMAB) seeking facial feminization surgery aged 30 years or older were included in the study. Central and forehead length were collected at initial consultation visits. Variables that potentially influence hair growth were collected by chart review, including age, duration of hormone replacement therapy (HRT), presence of spironolactone, and presence of other hair treatments, including finasteride, dutasteride, or minoxidil. Multivariable linear regressions were constructed with relevant predictor variables, while also incorporating global health scores as a proxy for psychological effects on hair loss. Results171 patients were included in this study, with a median age of 36.0 [interquartile range (IQR): 32.0-46.0] years and a median HRT duration of 2.0 [1.0-6.0] years. Multivariable linear regressions revealed no significant predictors for central forehead length. On the other hand, lateral forehead length was positively predicted by age (B=0.06, 95% confidence interval (CI) [0.03-0.08], p<0.001) and hair treatment (B=0.66, 95%CI [0.14-1.18], p=0.01), but negatively predicted by HRT duration (B=-0.07, 95%CI [-0.10- -0.04], p<0.001). ConclusionsAlthough older age is a predictor of lateral hairline recession in TGNB AMAB individuals, lateral forehead length was also predicted to decrease by 0.07cm with each year of feminizing hormone therapy in patients over 30 years of age.

Commentary on “Oestrogen hormone therapy stabilizes lateral hairline in transfeminine patients: Implications for facial feminization surgery”

Commentary on “Oestrogen hormone therapy stabilizes lateral hairline in transfeminine patients: Implications for facial feminization surgery”

Skeletal Manifestations of Gender-Affirming Medical Interventions for Aiding in the Preliminary Identification of Trans Individuals

Because of systemic discrimination, transgender individuals are at greater risk of being the victims of violence and of homicide. Accurate post-mortem identification from skeletonized remains of transgender individuals must be incorporated into a new standard for forensic anthropological analyses. A critical component of any investigation is the assessment of skeletal remains for evidence of gender-affirming care. A systematic review of the current medical literature was conducted to compile in one document descriptions of changes that could be used by forensic anthropologists to recognize skeletal manifestations resulting from gender-affirming surgeries, including facial feminization surgery (FFS), shoulder width reduction surgery, and limb-lengthening procedures. These skeletal changes, when present bilaterally and without evidence of healed trauma, serve as key indicators of a person’s transgender identity postmortem. Recognizing common patterns in bone structure alterations due to gender-affirming interventions will assist in identifying transgender individuals and providing closure for families. By integrating markers from gender-affirming care practices into forensic investigations, this research contributes to more inclusive and rigorous forensic investigations.

Sex classification of 3D skull images using deep neural networks

Determining the fundamental characteristics that define a face as "feminine" or "masculine" has long fascinated anatomists and plastic surgeons, particularly those involved in aesthetic and gender-affirming surgery. Previous studies in this area have relied on manual measurements, comparative anatomy, and heuristic landmark-based feature extraction. In this study, we collected retrospectively at Cedars Sinai Medical Center (CSMC) a dataset of 98 skull samples, which is the first dataset of this kind of 3D medical imaging. We then evaluated the accuracy of multiple deep learning neural network architectures on sex classification with this dataset. Specifically, we evaluated methods representing three different 3D data modeling approaches: Resnet3D, PointNet++, and MeshNet. Despite the limited number of imaging samples, our testing results show that all three approaches achieve AUC scores above 0.9 after convergence. PointNet++ exhibits the highest accuracy, while MeshNet has the lowest. Our findings suggest that accuracy is not solely dependent on the sparsity of data representation but also on the architecture design, with MeshNet's lower accuracy likely due to the lack of a hierarchical structure for progressive data abstraction. Furthermore, we studied a problem related to sex determination, which is the analysis of the various morphological features that affect sex classification. We proposed and developed a new method based on morphological gradients to visualize features that influence model decision making. The method based on morphological gradients is an alternative to the standard saliency map, and the new method provides better visualization of feature importance. Our study is the first to develop and evaluate deep learning models for analyzing 3D facial skull images to identify imaging feature differences between individuals assigned male or female at birth. These findings may be useful for planning and evaluating craniofacial surgery, particularly gender-affirming procedures, such as facial feminization surgery.

Exploring the evolution of facial feminization and masculinization surgery: a bibliometric analysis and visualization study

BackgroundThis study aims to conduct a bibliometric analysis of the current literature related to facial feminization surgery (FFS) and facial masculinization surgery (FMS) to understand the patterns, trends, and evolution of research topics. In addition, it aims to objectively identify the important articles that constitute the primary backbone of the FFS/FMS literature and provide a resource for education and new studies in this emerging field.ResultsUsing the principles of the Leiden Manifesto, 384 publications from the Web of Science from 1987 to 2023 were analyzed. The analysis included cross-country collaboration, keyword trends, affiliations, co-citation networks, and clustering. The results showed an increasing trend in FFS/FMS publications, with the USA leading in both publications (n = 238) and citations (n = 2420). The most cited journal was the Journal of Plastic and Reconstructive Surgery. The results indicate a high growth rate, with an H-index of 34 and an average citation of 11.41 per article. Co-occurrence analysis revealed evolving keywords such as “forehead” (n = 52) and “quality of life” (n = 44). The timeline view illustrated the terms reflecting current areas of interest such as #patient satisfaction and #gender-affirming care.ConclusionThe study reveals the influence of countries, institutions, authors, and emerging trends, supporting the anticipation that FFS/FMS will be a critical field of study in the future. The findings contribute to understanding the global landscape of FFS/FMS research, facilitating informed decision-making for researchers, and clinicians in the field of maxillofacial surgery.

The Naso-Orbito-Frontal (NOF) Complex In Facial Feminization Surgery

Background: With the increasing demand for facial feminization surgery, there is a growing need for reliable and reproducible techniques to enhance outcomes. Objective: This study aimed to evaluate the effectiveness of single-stage Naso-Orbito-Frontal (NOF) complex reshaping in facial feminization surgery. Effectiveness was gauged by CT scan assessments and an unvalidated patient satisfaction survey at 6 months post-operative. Methods: The study included 155 transfeminine patients undergoing surgery of the upper third of the face. Outcomes were compared in patients receiving either Orbito-Frontal (OF) surgery or combined Naso-Orbito-Frontal (NOF) surgery. A comparative analysis of pre- and postoperative standardized CT scan sections was performed, focusing on multiple anatomic angles in two dimensions. A self-administered satisfaction questionnaire based on six FACE-Q items was completed at 6 months. Results: Among the 155 patients, 65 underwent OF surgery, and 90 underwent NOF surgery. The follow-up period ranged from 6 to 36 months, with an average of 18 months. Significant changes in craniometric measurements were observed: in the OF group, average changes in nasofrontal, frontal tilt, and metopion angles were +12.3±0.2°, -8.5±2.2°, and +20.0±0.1° respectively (p&lt;0.001); in the NOF group, same metrics were +28.5±0.3°, -9.3±2.4°, and +23.9±0.1° (p&lt;0.001). The NOF group demonstrated higher overall satisfaction (Median: 4/5) compared to the OF group (Median: 3/5). No early complications were reported. Conclusion: The NOF complex surgery is an effective approach in gender-affirming surgery of the upper third of the face, yielding predictable results and higher patient satisfaction. Level of Evidence 3.

Use of Titanium Mesh During Frontal Sinus Setback in Facial Feminization Surgery: Clinical Outcomes and Perspectives.

Brow position, hairline shape, and forehead projection may confer cis-feminine identity, and facial feminization surgery (FFS) can improve gender dysphoria among transfeminine patients. Depending on the Ousterhout classification, burring, osteotomy, anterior frontal sinus setback, and augmentation, with subsequent fixation via metal or bioabsorbable plates, can address forehead projection. However, titanium mesh, often used in frontal sinus fracture repair, has not been described for forehead contouring in FFS. The purpose of this study was to study clinical outcomes associated with the use of titanium mesh for the stabilization of bone following anterior frontal sinus setback. A retrospective cohort study of trans-female and nonbinary patients undergoing primary FFS by our senior author between January 2021 and February 2023 was performed. Variables collected include demographics, Ousterhout classification, operative details, complications, and follow-up duration. Patients with prior FFS or facial trauma were excluded. Data were analyzed using SPSS, (IBM, Armonk, NY). Forty-three transfeminine patients were included for analysis. The cohort had an average age of 33.0±8.7 years and a median follow-up time of 3.0 months (IQR = 1.0-7.0). Among our cohort, 26 patients (60.5%) received titanium mesh and 17 patients (39.5%) underwent burring only for forehead contouring. There were no reported complications (ie, infection, hardware extrusion, or mucocele formation) or a need for forehead revisions among the entire cohort regardless of the frontal sinus reconstruction material utilized. Clinical outcomes were favorable among patients receiving titanium mesh anterior table fixation during FFS. Titanium mesh can be considered as an additional technique for frontal bossing reduction and anterior table fixation in FFS.

Simultaneous open rhinoplasty and upper lip lift (bullhorn) as part of the facial feminization surgery

Introduction. The face is one of the most visible external gender markers, and misinterpretation of the appearance of transsexual people by others can not only affect the mental health of these patients, but also exacerbate the discrimination resulting from transphobia. As the central structure of the face, the nose is located in the middle third of the face and plays an important role in the perception of femininity. The lip area is the aesthetic focus of the lower third of the face. Correction of the area of the upper lip reduces the distance from the base of the nose to the vermilion zone that gives these patients femininity, harmonizes the anthropometric proportions of the face and forms a female type of smile. Thus, the upper lip lift (bullhorn) is a very important component of facial feminization. Taking into account the proximity of the above anatomical zones and the need to perform several tasks during facial feminization surgery, our team made a decision to perform simultaneous correction of the nose and upper lip area, which was the subject of our study. The purpose of this research was to study the effectiveness and safety of a combination of these surgical interventions.Material and methods. We performed a complex of operations: simultaneous open rhinoplasty and lip lift (bullhorn) according to the original method to 10 Caucasian patients living in Eastern Europe at the age of 18 to 40 years with the diagnosis of transsexualism, nuclear type at the Department of Oncology, Radiation Therapy, and Reconstructive Surgery of the Institute of Clinical Medicine of the Sechenov First Moscow State Medical University (Moscow) during the period from January 2020 to December 2022. In combination of open rhinoplasty and bullhorn, we combine the same incision, while the skin is completely lifted above the columella so as to visualize the medial crura of the lower lateral cartilages.Results. We observed the patients operated by us for 6-24 months after the surgery. No intraoperative surgical complications were noted during these operation complex. We conducted a survey using a 5-point Likert scale to assess the degree of satisfaction with the results of surgery, changes in their quality of life and psychosocial status after surgery. All patients were fully satisfied with the quality of the postoperative scar. All patients operated by us noted a significant improvement in their quality of life after surgery.Conclusion. Thus, the method of simultaneous feminizing rhinoplasty and bullhorn performed by us has a number of advantages. With the combination of feminizing rhinoplasty and bullhorn surgery, it is possible to guarantee that the face will acquire a more feminine and harmonious look Введение. Лицо является одним из наиболее заметных внешних признаков, определяющих половую принадлежность, и неверная интерпретация другими людьми внешности транссексуалов может не только повлиять на психическое здоровье данных пациентов, но и усугубить дискриминацию, возникающую вследст- вие трансфобии. Как центральная структура лица, нос занимает среднюю треть лица и играет важную роль в восприятии женственности. Область губ в свою очередь является эстетическим фокусом нижней трети лица. Коррекция области верхней губы сокращает расстояние от основания носа до красной каймы верхней губы, что придает данным пациентам женственность и гармонизирует антропометрические пропорции лица и формирует женский тип улыбки. Таким образом, подтяжка верхней губы (булхорн) является очень важным компонентом феминизации лица. Учитывая близость вышеуказанных анатомических зон и необходимость выполнения нескольких задач при феминизирующих операциях лица нашей командой было принято решение об одномоментной коррекции носа и области верхней губы, что явилось предметом нашего исследования. Целью данного исследования явилась изучение эффективности и безопасности комбинации данных опе- ративных вмешательств. Материал и методы. На клинических базах кафедры онкологии, радиотерапии и реконструктивной хирургии Института клинической медицины Первого МГМУ им И.М. Сеченова в период с января 2020 по декабрь 2022 г. был выполнен комплекс операций: одномоментная открытая ринопластика и подтяжка губы (булхорн) по оригинальной методике у 10 пациентов европеоидной расы, проживающих на территории Вос- точной Европы в возрасте 18 от до 40 лет с диагнозом: транссексуализм, ядерный тип. При одновременном выполнении открытой ринопластики и булхорн совмещали один и тот же разрез, при этом кожа полностью приподнималась над колумеллой для визуализации медиальных ножек нижних боковых хрящей. Результаты. Прооперированных пациентов наблюдали на протяжении 6–24 месяцев после операции. В процессе выполнения данных операций никаких интраоперационных хирургических осложнений не отме- чалось. Мы провели опрос с использованием 5-балльной шкалы Лайкерта для оценки степени удовлетво- ренности результатами операций пациентов, изменения качества их жизни и психосоциального статуса после операции. Все пациенты были в полной мере удовлетворены качеством послеоперационного рубца. Все прооперированные пациенты отметили существенное улучшение качества их жизни после операции. Выводы. Таким образом, используемая методика одномоментного выполнения феминизирующей рино- пластики и булхорн имеет ряд преимуществ. При сочетании феминизирующей ринопластики и операции булхорн можно гарантировать факт, что лицо приобретет более женственный и гармоничный вид.

Effect of Facial Feminization Surgery (FFS) on Eyelid Anatomic Features.

Facial feminization surgery (FFS) improves gender dysphoria. The brows and eyes are crucial in perceived gender, yet brow and eyelid surgeries are relatively underutilized. This study aimed to determine rates of brow and eyelid surgeries as part of FFS and characterize pre- and postoperative periocular features. We conducted a retrospective review to identify all patients with the diagnosis of gender dysphoria who underwent FFS at a single academic institution from 2019 to 2022. Thirty-four patients comprising 38 surgical cases were included. Twelve (35%) eyelid surgeries and 27 (79%) brow lifts were performed. Baseline eyelid measurements did not differ between brow lift and nonbrow lift cases. Those undergoing brow lift and eyelid surgery were older in age (p = 0.022), had a higher rate of negative canthal tilt (p = 0.050), and smaller baseline margin-reflex distance 1 (p = 0.014) than patients who had brow lift alone. Brow lift increased tarsal platform show (p ≤ 0.001) and lash-to-brow distance (p ≤ 0.001), and upper blepharoplasty increased tarsal platform show (p = 0.01). Rates of brow lift are high at our institution, and patients are appropriately selected for eyelid surgery in FFS. Brow lift and upper blepharoplasty can feminize anatomical features when using standards described for cisgender cohorts. The impact of periocular features on gender perception in transgender patients warrants further study.

D146. Moving To 3D: Post-Surgical Cephalometric Changes and Surgical Planning Accuracy using Volumetric Analysis in Facial Feminization Surgery

D146. Moving To 3D: Post-Surgical Cephalometric Changes and Surgical Planning Accuracy using Volumetric Analysis in Facial Feminization Surgery

Ethnic variation in lower face anthropometry on facial computed tomography scans for patients seeking facial feminization surgery

BackgroundFacial feminization surgery (FFS) is the most common form of facial gender-affirming surgery. One of the current knowledge gaps is the understanding of racial group differences in baseline craniofacial norms for transgender and nonbinary patients. MethodsAll patients who sought consultation for FFS with a completed craniofacial computed tomographic (CT) scan at a single institution between the years of 2018 to 2023 were included. Patients with previous facial surgeries were excluded. Chart reviews were conducted for patient characteristics, including race, age, hormone therapy duration, and prior gender-affirming surgeries. Racial categorizations included White, Latinx, African American, or Asian. Patients with other or multiracial identity were excluded. Measurements of the lower face were derived from preoperative facial CT scans. Comparative analyses were performed on all measurements between racial groups. Results204 patients were included with an average age of 32.0±10.2 years and a median hormone duration of 2.0 years. Notable racial group differences were: 1. Zygomatic width was largest in Asian patients (13.5±0.6cm) compared to all other racial groups (p=0.03), 2. Nasolabial angle was smallest in African American patients (82.5±13.1 degrees, p<0.001), 3. Lower face height was largest in African American patients (6.9±0.7cm, p<0.001) and 4. Lateral mandibular flare was largest in African American patients (0.4±0.1cm) and smallest in Latinx patients (0.2±0.1cm, p<0.001). ConclusionsSpecific target areas of FFS should be carefully considered to account for possible baseline ethnic differences. Relative facial proportions may also be a more salient surgical planning tool for TGNB patients rather than absolute measurements alone.

94. Moving To 3D: Post-Surgical Cephalometric Changes And Surgical Planning Accuracy Using Volumetric Analysis In Facial Feminization Surgery

94. Moving To 3D: Post-Surgical Cephalometric Changes And Surgical Planning Accuracy Using Volumetric Analysis In Facial Feminization Surgery

Ambulatory facial feminization surgery: a comparative analysis of outcomes and complications

BackgroundTo date, there are no studies investigating the safety and outcomes of facial feminization surgery (FFS) as an outpatient procedure. This is the first study of its kind analyzing the outcomes of ambulatory FFS based on a comparison of complications, post-operative emergency department or urgent care (ED/UC) visits, and readmissions between patients who underwent FFS with admission versus same-day surgery. MethodsA retrospective analysis was conducted on all patients who underwent FFS in a single integrated healthcare system. Patient charts were reviewed for operative details, complications, post-operative ED/UC visits, readmission, and demographic factors. Major outcomes including complications, readmissions, and ED/UC visits were compared between groups with same-day discharge and post-operative hospital admission. ResultsOf 242 patients included in the study, ED/UC visits were comparable between patients discharged same-day (18.2%) and patients admitted post-operatively (21.6%, p = 0.52). Logistic regression showed no significant difference in the composite outcomes of minor complications, major complications, and readmissions (15.6% for ambulatory versus 19.3% for admission, p = 0.46). Temporary nerve palsy, infection, and hematoma were the most common post-operative complications. However, covariates of a lower face procedure and operative time were shown to have significant differences in the composite complication outcome (p = 0.04 and p = 0.045, respectively). ConclusionAmbulatory FFS is a safe practice with no associated increase in adverse outcomes including complications, ED/UC visits, and readmission when compared to post-operative admission. Adoption of same-day FFS should be considered by high-volume gender health centers to potentially benefit from increased scheduling flexibility and efficiency, increased access to care, and lower healthcare costs.

F-Chin/Feminizing the Chin: A Genioplasty Technique with Virtual Planning for Male-to-Female Transgender Patients.

The chin is an essential structure in facial harmony and an important gender marker. Advancing a receding chin is fundamental to improve the facial appearance, particularly in male-to-female transgender patients. However, in patients with microgenia and/or retrognathia, desiring a more feminine appearance, a chinadvancement can result in a wider, square shape; an undesirable effect. Genioplasty is a versatile procedure used in facial feminization surgery that allows modifying the natural anatomy of the chin in all three spatial dimensions. The technique herein described proposes a simple genioplasty procedure for feminizing the chin (F-chin genioplasty) in transgender patients where anteroposterior advance is required. Virtual planning was used to establish the landmarks for an anteroposterior advancement with transverse reduction in the chin. A perpendicularline to the Frankfurt plane passing through the incisal edge of the upper central incisor was used to plan the anteroposterior movement, and two vertical lines on the outer wall of the nasal cavity for thechin transverse measurement. The authors presentthree case reportswith the F-chin genioplasty transgender technique with satisfactory results, ensuring a more feminine facial appearance.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Secondary Forehead Lift in Transgender Women.

Facial feminization surgery includes a series of procedures that aim to attenuate the masculine features of the face and make the face more feminine and harmonic. During the past few years, several feminization techniques have been developed or adapted to this discipline. The current intervention of the forehead for feminization is based on the setback of the anterior wall of the frontal sinus and the remodeling of the supraorbital and glabellar region, associated to brow lift and hairline advancement. Primary forehead feminization yields high patient satisfaction, quality of life, and aesthetic outcomes, with few complications. Despite this, secondary forehead lift in feminization surgery has grown rapidly in recent years due to two main reasons: (1) patients that had their primary forehead surgery 5 or more years ago kept aging; and (2) there was also a great increase in the primary surgeries, which also comes with increased unsatisfied patients that want a revision. In the present study, we will present our current approach for secondary forehead lift in transgender women and tips to avoid a revision when performing the primary forehead reconstruction.

Artificial Intelligence Suggests Greater Visual Conformity with Affirmed Gender After Facial Feminization Surgery.

Artificial Intelligence Suggests Greater Visual Conformity with Affirmed Gender After Facial Feminization Surgery.

Facial Anthropometric Analysis of Gender-Related Characteristics in Computed Tomography.

In recent years, facial feminization surgery (FFS) has gained increasing popularity because of increases in transgender individuals and the acceptance of diversity in gender identity. However, there is still a scarcity of anthropometric research to guide evidence-based practices for FFS in Taiwan. The purpose of this study was to provide a reference for surgeons to achieve optimal outcomes for patients undergoing FFS. The anthropometric analysis could help surgeons meet patients' specific requirements and improve patients' alignment with their gender identity. The study group consisted of 100 patients (50 males and 50 females) who had undergone cranial computed tomography at Chang Gung Memorial Hospital in Taiwan because of the indication of blunt injuries to the head and face with suspected skull and facial fractures. The computed tomography images were imported into the OsiriX image software to conduct an anthropometric evaluation. The parameters used in the measurements included 2 aspects: bone and soft tissue anthropometric analysis. Anthropometric data were obtained from 50 males (age 32.6 ± 11.4 years) and 50 females (age 33.7 ± 10.3 years). The results for bone measurements showed that both the forehead bossing length and nasal bone width in the male group were significantly greater. The frontal angle in both bone and soft tissue in the male group was significantly smaller. The chin height and bigonial width in both bone and soft tissue in the male group were significantly greater. Although the average gonial angle was greater in the female group, the difference was not significant. For the measurements of lip projection, the results showed that there was no significant difference. Although this group of Asian males had more acute nasolabial angles, the difference was not statistically significant. However, the average nasofrontal angle among females was significantly more obtuse than among males. The results revealed that Asian males tend to have more prominent superior orbital rims, wider nasal bones, and wider and taller mandibles compared with Asian females. Despite showing some trends, the gonial angle and lip projections did not reveal any significant differences, which is likely because of a large amount of variation.

Facial Feminization: Perioperative Care and Surgical Approaches.

After studying this article, the participant should be able to: 1. Understand the regional anatomy involved in facial feminization surgery, the key differences between the male and female face, and surgical approaches for modification. 2. Appreciate the integration of preoperative virtual planning and nonoperative approaches for facial feminization care. 3. Understand the perioperative process and potential complications and sequela. 4. Understand the importance of transgender care acceptance as it pertains to clinical outcomes. Facial feminization surgery (FFS) is composed of a broad spectrum of gender-affirming surgical procedures with the goal of modifying specific facial features to create a more feminine appearance. As FFS continues to evolve as a subspecialty of transgender care, it is important to consider the psychosocial evaluation, evolving aesthetic tastes, nonoperative facial feminization care, preoperative virtual planning, specialized instrumentation, and potential complications/sequelae when performing these procedures. Computed tomographic imaging and virtual preoperative planning may be used to assist the surgeon with morphologic typing of the brow, supraorbital rim, chin, and lateral mandible regions and aid in performing safer, more efficient procedures. The increasing number of FFS procedures performed on transwomen annually has been supported by objective outcome studies that demonstrate progress in minimizing both misgendering in social environments and reducing dysphoric feelings.

Facial feminization: An orthodontic perspective – A scopic review

Facial feminization surgery (FFS) is the sequential procedure for reshaping the face to appear more feminine. It is usually take on due to transsexual individuals who want transformation from men to women or for the females want to wish for more advanced feminize facial features. Multidisciplinary treatment planning team is the basic necessity for any patient who is seeking for FFS. Orthodontists possess the chief characteristic within the multidisciplinary team because patients may initially appear to the orthodontist for the concern of their jaw appearance. For that reason, orthodontists should have the detailed knowledge about FFS procedures, to authorize the best communication with the patient, thorough the assessment of the patient and further referral where there is the requirement. Present article reviews the commonly used FFS procedures, their implications, benefits as well as the risk factors of every procedure and highlights the orthodontist’s role.

Facial Feminization Surgery: Anatomical Differences, Preoperative Planning, Techniques, and Ethical Considerations.

Facial Feminization Surgery (FFS) is a transformative surgical approach aimed at aligning the facial features of transgender women with their gender identity. Through a systematic analysis, this paper explores the clinical differences between male and female facial skeletons along with the craniofacial techniques employed in FFS for each region. The preoperative planning stage is highlighted, emphasizing the importance of virtual planning and AI morphing as valuable tools to be used to achieve surgical precision. Consideration is given to special circumstances, such as procedure sequencing for older patients and silicone removal. Clinical outcomes, through patient-reported outcome measures and AI-based gender-typing assessments, showcase the efficacy of FFS in achieving proper gender recognition and alleviating gender dysphoria. This comprehensive review not only offers valuable insights into the current state of knowledge regarding FFS but also emphasizes the potential of artificial intelligence in outcome evaluation and surgical planning to further advance patient care and satisfaction with FFS.