Facial feminization surgery: surgical techniques and analysis of results in 200 patients

Exclusion of Medically Necessary Gender-Affirming Surgery for America's Armed Services Veterans

“…There is strong and rapidly accumulating evidence that patients with gender dysphoria benefit from mental health, hormonal, and reconstructive surgical interventions during the social transition from their assigned to their intrinsic gender. Although there are no large multicenter studies in this area, multiple retrospective and a smaller number of single-center prospective studies on facial feminization [16][17][18][19], chest reconstruction [20], and genital sex reassignment [21] clearly demonstrate that gender-affirming surgery substantially improves the mental and physical health of transgender patients. This convincing body of evidence has led many major professional organizations, including the American Medical Association [22], the World Professional Association for Transgender Health [23], the National Association of Social Workers [24], the American Public Health Association [25], the American Society of Plastic Surgeons, the American Psychiatric Association, the American Psychological Association, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the Endocrine Society to endorse the medical necessity of genderaffirming care, including gender-affirming surgery, for people with gender dysphoria [26].…”

Facial feminization procedures: the western approaches to the forehead

“…Reduction of the bossing, including the frontal processes of the zygomas and the lateral superior orbital rims, can be burred to smooth away any bony infringement and to expand the orbital perimeter. Ousterhoust, Altman, Capitan, and Komuro reported the use of either pineapple or methylmethacrylate burr [1,[7][8][9].…”

“…In most cases, the frontal nasal angle is acute [7][8][9], and therefore osteotomy planning should include the inferior aspect of the anterior table of the frontal sinus at the glabella, and immediately above the radix.…”

“…These cuts can be made safely with a fissure burr or sagittal saw facing towards the sinus at all times in order to ensure correct positioning [4,7,8]. The author uses fissure burr, while Altman reported use of both, and Komuro used a sagittal saw.…”

“…Forehead contours can be improved with augmentation of the entire forehead with implants or bone cement. In types I and III, some surgeons obtain pre-operative computed tomography (CT) scans to confirm the forehead types and plan for facial surgery [7,8]. Spiegel reported safe sinus intervention without pre-operative CT scan [4], though the author also recommended pre-operative imaging, either by cephalogram or CT scan, for surgical planning and pre-operative counseling.…”