Facial feminization surgery is a recognized collection of facial reshaping procedures that are primarily used in the treatment of gender dysphoria. Based on recognized anthropometric studies, the key craniofacial characteristic that separate a male from a female face is the shape of the forehead, the frontonasal junction and the shape of the chin. Thus, facial feminization surgery encompasses forehead recontouring/brow bone reduction, rhinoplasty, chin/jawline reduction/reshaping and tracheal shaves.
While facial feminization surgeries are becoming more commonly performed, an important question is how successful is this surgical process. Before and after surgery pictures can show either modest or significant changes, but how are the results perceived by the transgender patients on whom they are performed?
In the February 2016 issue of the journal Plastic and Reconstructive Surgery, the paper entitled ‘Full Facial Feminization Surgery: Patient Satisfaction Assessment Based on 180 Procedures Involving 33 Consecutive Patients’. In this study, an assessment of patient satisfaction after male to female FFS procedures that included outcome measurements after forehead and chin remodeling. Thirty-three (33) patients between the ages 19 and 49 years old over a ten year period were treated with a total of 180 facial procedures. The authors used a FFS flow chart that included two basic combined hard and soft tissue steps that are completed in six months. Step 1 is orthognathic surgery, rhinoplasty and chin/jaw reshaping (hard tissue) and/or facelift, blepharoplasty and structural fat grafting. Step 2 is forehead and orbital reshaping (hard tissue) and/or hairline lowering/browlift, tracheal shave and neck liposuction.
All treated patients showed excellent cosmetic results and were satisfied with their procedures. Photographs showed a successful loss of masculine features. Patient satisfaction after facial feminization surgery in this patient series was high. The facial physical improvements had significant psychological and social benefits that improved their quality of life.
This clinical FFS series is unique in several ways. First their approach to FFS surgery is somewhat different in that it introduces orthognathic surgery as part of the first stage. While there are some transgender patients that would benefit by this type of facial skeletal surgery, it would apply largely to younger patients who are more willing to commit to an investment in that effort. Most transgender patients I have seen and treat would have little interest in facial osteotomies unless they have a major malocclusion. Secondly, they treat the lower half of the face first, followed by a second stage attention to the upper face. For many transgender patients, the forehead is often a high priority and is often done first and there is no guarantee there will be another opportunity for additional procedures later.
While it is clear there is no exact ‘formula’ for how to stage or even perform facial feminization surgery, various approaches can be used. When the procedures are done successfully, whether in a comprehensive single stage or in multiple stages, patient satisfaction surgery with FFS can be quite high.
Dr. Barry Eppley