Facial Masculinization Research Articles

Enhancements in Clinical Practice in the Contemporary Landscape of Male Facial Attractiveness

The concept of gender has evolved significantly in recent decades, moving from a binary status to a multiplicity of gender types. In today’s world, the new reality of the concept of masculinity, as defined socially and historically, must be recognized and accepted by aesthetic medicine. Consequently, aesthetic doctors will have to adapt the views and treatment plans that they propose in their consultations to the ideals of beauty, as well as with the roles, behaviors, and attributes considered masculine within their society. Each facial feature suggests a personality characteristic that represents that individual. This expert opinion article aims to assess Caucasian male gender-related anatomical facial features and achieve an expert agreement on the association of specific features with the perception of attractiveness, masculinity, and personality traits in order to cover the wide range of current male representations, as well as to provide orientation for clinical practice improvement in the contemporary landscape of facial masculinization.

Facial Masculinization Surgery Using Polyetheretherketone Alloplasty: Statistical Shape Modeling-based Implant Designs.

The face is the initial feature used to judge gender in public spaces; it is also a source of significant gender dysphoria. Surgical techniques are available for non-cisgender male patients who desire a more masculine face by augmenting certain features to change the bony framework of the skull. Augmentation using virtually designed patient-specific polyetheretherketone implants has now become a more widely applied method in maxillofacial surgery. When designing implants for augmentation, a three-dimensional (3D) reference or template is very useful. Hence, a 3D statistical shape model was developed of a male skull shape from information from a population of 40 male patients containing the mean shape and principal components of shape variation. By overlaying the template and the patient's 3D skull model, this method identified the regions of gender dimorphism in this case to be the orbital ridge, zygomatic regions, and frontal bossing area. Based on the 3D template overlay, polyetheretherketone augmentation implants were virtually designed in close consultation with a patient to augment the aforementioned regions. The virtual statistical shape modeling template offered an objective reference, and the possibility to fully involve the patient in the treatment planning.

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.

A Review of Aesthetic Considerations for Treating the Transgender Patient.

As gender diversity becomes increasingly embraced by society, and despite growing recognition of the unique needs of transgender patients, the literature remains devoid of guidelines for gender affirming facial feminization or masculinization techniques. The authors seek to identify and discuss target feminine and masculine facial features, as well as an armamentarium of surgical and nonsurgical strategies to effectively address and achieve them in the transgender population. A search of the National Library of Medicine database (PubMed) was undertaken to identify the existing literature on gender-affirming facial feminization and masculinization techniques. The importance of assessing proportional relationships between the bitemporal, bizygomatic, and bigonial distances is discussed; ideal masculine faces possess a rectangular face shape, with ratios for these 3 areas tending toward 1:1:1. Conversely, the ideal female face is heart shaped with projection at the zygoma and a tapered jawline. Strategic positioning of the cheek apex serves as an anchor in sculpting a distinctly masculine or feminine face. Other considerations include the enhancement of skin quality and implications of hormonal therapy. The aesthetic considerations provided in this study can serve as a valuable guidance for aesthetic physicians seeking to deliver optimal care for their transitioning patients.

Virtual Modeling in Gender-Affirming Facial Masculinization Surgery.

The increase in access to facial gender-affirming surgery has resulted in a rise in facial feminization surgeries for transfeminine and gender non-binary populations. However, refined execution of facial masculinization is challenged by the lack of defined measurements for facial augmentation, the lack of long-term predictability in autologous bone grafting in augmentation procedures, and the lack of precision in traditional facial augmentation procedures with generic alloplastic implants. In this work, we describe an innovation in facial masculinization surgery using modern reconstructive craniofacial surgical techniques with preoperative virtual modeling and the fabrication of three-dimensionally printed, patient-specific custom implants.

A multimetric health literacy analysis of online gender affirmation surgery materials: From facial to genital surgery

The transgender patient population is expanding, and gender affirming surgery (GAS) volume is increasing. Accurate, comprehensive, and easily navigable resources on GAS are lacking. We aim to evaluate the readability of online materials for specific gender affirming surgical procedures to identify mechanisms of improving information access for transgender patients. "Facial feminization", "facial masculinization", "MTF breast augmentation", "FTM chest masculinization", "MTF vaginoplasty", "metoidioplasty", and "FTM phalloplasty" were searched on Google. Per keyword, the first 75 text-containing results were included. Text was analyzed for reading difficulty using the Flesch-Kincaid Reading-Ease (FKRE) test and grade level using the Flesch-Kincaid Grade Level (FKGL) formula, Gunning Fog Index (GFI), Simple Measure of Gobbledygook (SMOG), and Coleman-Liau Index (CLI). Scores were compared using independent t-and ANOVA tests (α=0.05). Mean readability scores (FKRE 37.44) and grade-levels (FKGL 12.87, GFI 15.61, SMOG 11.91, CLI 15.00) correlated with college-level difficulty. Masculinizing surgical materials were more difficult to read than feminizing ones (p≤0.023). Top surgery materials were easier to read than facial and genital surgery materials (p≤0.013). Specifically, chest masculinization resources were more difficult to read than those for breast augmentation (p≤0.006). No differences were found between facial feminization and masculinization surgery resources, nor between resources for different gender affirming genital surgeries. Online GAS materials are written above the recommended 6th grade reading-level, with resources for transgender men being significantly more challenging to understand. Improving readability of online resources can help overcome barriers to care for the transgender patient population.

Facial Masculinization Surgery: A Consolidated Approach

Facial masculinization surgery represents a group of procedures that are aimed at achieving better congruence between facial anatomy and internal gender identity in transgender men.1 Although techniques for performing facial feminization surgery are widely described, surgical masculinization techniques are underreported. First-line therapy for facial masculinization includes testosterone therapy; however, in many patients, adequate masculinization is not achieved with hormone therapy alone, in which case surgery may be pursued. Herein, we describe surgical pearls of a consolidated approach for facial masculinization. The study was approved by the institutional review board (17-22646) at the University of California San Francisco, and all patients consented for pre- and postoperative digital photographs with consent for research and publication use. No competing financial interests exist. No funding was received for this article. Runtime of video: 5 mins 45 secs

Facial Masculinization Surgery: An Analysis of Interest Trends Using Search Term Analysis.

Facial masculinization surgery (FMS) is increasingly popular among cisgender and transgender men. The benefits of FMS are focused on facial identity and have been proven to decrease gender dysphoria in this population. Previous research showed increasing interest in gender affirmation surgery and facial feminization surgery, but the prevalence of FMS has not been explored. It is difficult to find these data based on surgical records alone because institutions do not have standardized methods of reporting and lack publications in the field. Our study aimed to analyze public interest in FMS by using worldwide Google Trends to quantify these trends. A worldwide Google Trends search was completed from January 1, 2008, to December 31, 2022, for terms focused on FMS. Then, search terms were analyzed for nonfacial masculinization procedures and were aggregated. Lastly, a PubMed search was conducted for the terms "transgender" and "facial masculinization" from January 1, 2008, to December 31 st , 2022, to compare publication rates. Our data showed an increasing interest in FMS through Google search trends since the year 2008. A similar trend was demonstrated for non-FMS gender-affirming terms. PubMed analysis showed "transgender" medicine publishing rates were approximately 39.65 times greater than "facial masculinization" publishing rates, although "facial masculinization" medicine did produce a positive trend over the study period of approximately 4 publications per year. The medical literature on transgender surgeries rapidly outpaces publications specifically focusing on FMS. Our study showed increasing interest in gender affirmation surgery over time, particularly FMS. These increasing trends should encourage greater scientific exploration of FMS and research to properly quantify and assess surgical outcomes in this special population. Additional educational interventions for both the general public and medical providers, to increase awareness of unique challenges that impact this community and highlight changes in health care coverage over time, should be created to keep pace with increasing patient demand and address the physical, systemic, and psychosocial issues faced by people who identify as transgender.

Facial masculinization surgery

Facial masculinization surgery

Current challenges faced by transgender and gender-diverse patients and providers in anesthesiology.

Current challenges faced by transgender and gender-diverse patients and providers in anesthesiology.

An Overview of Gender-affirming Surgical Fellowships in the United States

PURPOSE: In recent years, there has been a significant increase in the awareness and demand of gender transition surgery. Surgical transition often occurs in specialized centers due to the involvement of a multidisciplinary team. Thus, residents may have limited clinical experience in gender transition and seek out fellowships. This study aims to assess the formation and characteristics of gender-affirming surgical fellowships in the United States. METHOD: A cross-sectional study was performed on all institutions with an accredited plastic surgery residency program in the United States. The official website for each program was reviewed for the presence of a gender transition fellowship. The authors then contacted program coordinators through email or telephone interview to collect data on the characteristics of the fellowship. RESULTS: The authors included 102 academic institutions in this study, less than half (n=48, 47%) were known as ‘Leader in LGBT Healthcare’ centers. Seven transgender fellowships were identified; however, data was only available for 6 fellowships. All fellowships (n=6) had a 12 month duration and the average stipend was $81,225. All offered training in masculinizing and feminizing chest reconstruction. Five provided training in both masculinizing and feminizing genital reconstruction (83%), whereas one fellowship provided training in neither. Strikingly, significantly more fellowships offered facial feminization training than facial masculinization (83% vs 33%, p<0.001). CONCLUSION: The creation of transgender surgery fellowships in plastic surgery reflects the growing demand for gender-affirming surgical training and provision. Although there is universal fellowship training in chest reconstruction, there are fewer learning opportunities for genital reconstruction and facial masculinization surgery.

Facial transsexualizing procedures in people with gender dysphoria: literature review

INTRODUCTION: Transsexuals are individuals who experience discomfort or anguish caused by the discrepancy between their gender identity and their assigned sex at birth, so they intensely experience the need to experience the opposite gender. The main purpose of facial masculinization and feminization is to provide the transsexual individual with a face that matches their real gender and make them accept, recognize and identify themselves by looking in the mirror, without harm or discomfort. OBJECTIVE: To carry out a review of the literature on facial transsexualization procedures to which transsexual men and women are submitted. METHODOLOGY: A literature review was carried out, highlighting the use of databases: VHL, Google Scholar, LILACS, PubMed, SciELO and Web of Science. Articles in Portuguese and English were used as selection criteria based on the descriptors from the MeSH (Medical Subject Headings) and DeCS (Descriptors in Health Sciences): transsexualism OR sex reassignment procedures OR gender identity AND feminization OR masculinization. RESULTS AND CONCLUSION: 25 studies were included to compose this review. Facial transsexualizing procedures promote confirmation and reduction of gender incongruity in transsexual individuals. There is a great scarcity of studies with this group of patients resulting from social transphobia, therefore, it is necessary to promote the awareness and training of all health professionals with the aim of reducing stigma and prejudice through information and the creation of protocols. services that understand the needs of transgender women and men.

32270 Health insurance coverage of injectable fillers and neurotoxins for gender affirmation

Introduction: Gender-affirming facial procedures are critical for reducing the mental health impact of gender dysphoria. Injectable neurotoxins and dermal fillers may be the only options for facial masculinization or feminization for many patients, including poor surgical candidates. However, the largest barrier to access is cost/insurance. This study aims to assess the extent of health insurance coverage of gender-affirming neurotoxin and filler procedures.

Facial Masculinization from Procedures to Payment: A Review.

As the demand for gender-affirming procedures continues to increase, patients and providers have a greater imperative to understand the current state of facial masculinization. Facial reconstruction for transgender women has been shown to treat gender dysphoria effectively and reduce rates of discrimination and victimization. Although facial masculinization surgery for transgender men is less common, there are multiple surgical and nonsurgical options to supplement the effect of hormone therapy on facial appearance, including but not limited to: receding the hair line, flattening the forehead, expanding the supraorbital ridge, increasing the dorsal nasal projection, squaring the jaw, and augmenting the chin. This review aims to summarize these techniques for providers who wish to inform transgender male patients about their options and discuss them in the context of patient satisfaction and availability of insurance coverage.

Minimally invasive aesthetic treatment of male patients: The importance of consultation and the lower third of the face.

BackgroundMen worry disproportionately about potential negative consequences of facial aesthetic treatment with injectable therapies, such as side effects or appearing more feminine. Features of the lower third of the face (eg, prominent chin and jaw) are particularly important in perceptions of masculinity. A strategy has been developed for male patients based on an initial consultation emphasizing the safety and masculinizing potential of injectables, followed by treatment with a high G’ hyaluronic acid filler targeting the lower third.AimsTo assess this strategy in routine practice.MethodsThis was a retrospective analysis of male patients with poor definition of the lower third of the face wishing to undergo non‐surgical correction. Initial consultation focused on detailed patient education and facial masculinization with injectables. Individuals were then treated in the lower third using VYC‐25 based on the standardized MD Codes approach. Follow‐up lasted ≤12 months.ResultsForty patients were included (mean age: 40.9 ± 9.6 years). The mean volume of VYC‐25 injected into the lower third was 7.8 ± 1.2 ml. Patient satisfaction was high, as assessed using the FACE‐Q “Satisfaction with outcome” questionnaire (mean Rasch‐transformed score: 88.1 ± 10.3). Complications included the following: soft tissue edema, n = 12 (30.0%); hematoma, n = 6 (15.0%); and telangiectasia, n = 2 (5.0%). All were early, transient, and minor; there were no major or delayed events.ConclusionsThis approach to male subjects was practical and safe despite the large volumes of filler used. Focusing on the lower third may help to reassure patients and deliver results that respect masculine identity.

Point of care virtual surgical planning and 3D printing in facial gender confirmation surgery: a narrative review.

Facial gender confirmation surgery (FGCS) is a powerful set of procedures in the armamentarium of plastic surgeons that can transform the male face into a gender-congruent female face and provide the transgender individual with improved quality of life, positive body image and help in social integration. The goals of the FGCS procedures are to address the individual patients' concerns and expectations about their facial appearance, offer safely executed surgery, minimize complications, and optimize surgical outcomes. Pre-operative computed tomography (CT) scanning and three-dimensional (3D) reconstruction before facial feminization or masculinization delineates important skeletal and sinus anatomy and can also be a useful tool in patient consultation. Virtual surgical planning (VSP) is a valuable tool in facial surgery. From free flap bony reconstruction after tumor resection and orthognathic surgery to craniosynostosis planning, VSP has become widely utilized in modern day cranio-maxillofacial surgery. The use of patient-specific cutting guides and implants helps in improving symmetry and safety of these procedures. Furthermore, 3D printed models are valuable tools in patient education and counseling prior to surgery. In this article we describe our approach to FGCS through the integration of point of care (POC) VSP and 3D printing (3DP) to help deliver safer and accurate FGCS outcomes.

A review of gender affirmation surgery: What we know, and what we need to know

BackgroundGender-affirmation surgery is a rapidly growing field in plastic surgery, urologic surgery, and gynecologic surgery. These procedures offer significant benefit to patients in reducing gender dysphoria and improving well-being. However, the details of gender-affirmation surgery are less well-known to other surgical subspecialties and other medical subspecialties. The data behind gender-affirmation surgery are comparatively sparse, and due to the recency of the field, large gaps exist in the literature. MethodsPubMed searches were carried out specific to gender-affirming mastectomies, vaginoplasty, vulvaplasty, mastectomy, metoidioplasty, and phalloplasty. Combinations and variants of “gender affirming,” “gender confirming,” “transgender,” and other variants were used to ensure broad capture. Historical articles were also reviewed. The data gathered were collated and summarized. ResultsGender-affirmation surgery is generally safe. Complication rates for gender-affirming mastectomy and breast augmentation are very low, and complication rates for genital surgeries are also reasonably low. Gender-affirmation surgery decreases rates of gender dysphoria, depression, and suicidality, and significantly improves quality-of-life measures. Data regarding facial gender-affirming surgery are limited. There are very few patient-reported outcome measures specific to gender-affirmation surgery. ConclusionAlthough the data behind male-to-female gender-affirming surgery are more robust, there are significant gaps in the literature with respect to female-to-male surgery, surgical complication rates for genital surgery, facial masculinization and feminization, and patient-reported outcomes. We therefore present recommendations for further study.

Facial Hair Transplantation for Transgender Patients: A Literature Review and Guidelines for Practice.

Facial hair transplantation has become an increasingly popular modality to create a more masculine appearance for transmasculine patients. This aim of this study was to review the current literature regarding facial hair transplantation and provide recommendations and best practices for transgender patients. A comprehensive literature search of the PubMed, MEDLINE, and Embase databases was conducted for studies published through April 2020 for publications discussing facial hair transplant in transmasculine patients, in addition to the nontransgender population. Data extracted include patient demographics, techniques, outcomes, complications, and patient satisfaction. We identified 2 articles discussing facial hair transplantation in transmasculine patients. Due to the paucity of publications describing facial hair transplantation in transmasculine patients, data regarding facial hair transplant from the cisgender population were utilized to augment our review and recommendations. Facial hair transplant is a safe and effective means of promoting a masculine appearance for transgender patients. Nevertheless, facial hair transplantation should be deferred until at least 1 year after the initiation of testosterone therapy to allow surgeons to more accurately identify regions that would benefit the most from transplantation. Additionally, providers should engage patients in discussions about any plans to undergo facial masculinization surgery because this can alter the position of transplanted hairs. Currently, follicular unit extraction from the occipital scalp is the preferred technique, with use of the temporal scalp if additional grafts are needed. Patients should be advised that a secondary grafting procedure may be needed a year after initial transplant to achieve desired density.

Surgical Options for Patients Seeking Gender-Affirming Surgery

To describe the surgical treatments available to transgender women and men desiring gender-affirming surgery (GAS). Transgender patients who undergo GAS have high satisfaction and improved quality of life. Masculinizing procedures include chest reconstruction, facial masculinization surgeries, hysterectomy with bilateral salpingo-oophorectomy, metoidioplasty, and phalloplasty. Feminizing procedures include facial feminization surgeries, chondroplasty and voice surgeries, breast augmentation, orchiectomy, and genital surgeries, such as vaginoplasty and vulvoplasty. Vaginoplasty can be performed with inversion of penile skin, sigmoid colon, or peritoneal flaps. The most common GAS surgery in the United States is chest masculinization surgery. Major complications after penile-inversion vaginoplasty are infrequent. A wide range of surgical options exist for the treatment of gender dysphoria. In recent years, systematic reviews and meta-analysis data have shown high satisfaction and more consistent complication rates for GAS. Limited, multicenter data exist regarding surgical techniques, outcomes, and complications.

Barriers To Finding A Gender Affirming Surgeon.

Gender affirmation surgery is increasingly prevalent; however, finding a surgeon continues to be difficult. Additionally, the majority of transgender patients utilize the internet for information before elective surgery. Therefore, it is imperative to explore potential online barriers in finding a gender affirming surgeon. The authors sought to use the Internet to search for gender affirming surgeons practicing in the USA, and therefore, reflect the process that patients potentially undergo. We highlight the barriers to information and care that we encountered. We conducted a comprehensive review of public online transgender surgery directories for currently practicing surgeons that provide facial feminization, facial masculinization, breast augmentation, chest masculinization, vaginoplasty, metoidioplasty, and/or phalloplasty in the USA. Each surgeon's name, surgical specialty, the current practice's name, state, and zip code, and procedures provided were recorded. Chi-square analysis was used for comparisons of categorical variables. There are currently 660 gender affirmation surgeons in the USA, with most specializing in plastic surgery, followed by otolaryngology and urology. In total, 30.5% of surgeons practice in the West, 25.6% in the Northeast, 25.3% in the South, and 18.6% in the Midwest. The most common surgery provided was chest masculinization (70.2%), followed by facial feminization (42.7%) and chest feminization (42.6%). Plastic surgeons are most likely to perform gender affirmation surgery compared to other specialties. Geographic distribution of surgeons, does not, however, match the distribution of patients. Additionally, we encountered significant hardship in confirming that a surgeon performs the procedure listed in their profile on popular online gender affirmation surgeon directories. V.