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

Abstract

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.

Developments in facial feminization surgery

“…Innovative ways that VSP is being used are described by Kuruoglu et al [25] At their institution, all VSP is performed at their own institution, which expedites the process by eliminating the need for coordinating 1–2 web meetings with third parties and bypassing the shipping time. Further, the 3D printed models can be used to review the surgical plan with trainees and the patient themselves.…”

Establishing a Point-of-Care Virtual Planning and 3D Printing Program

“…Lastly, virtual surgical planning is performed digitally, and from this, 3D printed templates/guides are designed to facilitate the digital plan during the surgical procedure (►Fig. 6).…”

“…Such cost justifications include reduced surgical time at an average rate of $80.00 -$100.00 per minute, less reoperations and need for revisions, enhanced outcomes, reduced cost of surgical guides and virtual surgical planning, improved patient consent, reduced length of stay, and patient and physician satisfaction. [1][2][3][4][5][6][7][8][9][10][69][70][71][72][73][74] As alluded to in the workflow section, the category III CPT codes can assist with cost justifications. Even though they are temporary codes and do not guarantee reimbursement, it is highly encouraged to use these codes.…”

“…Through the development of 3D printed anatomic models and patient-specific surgical guides, this technological duo has led to more efficient and accurate surgeries improving outcomes. [5][6][7][8][9][10] 3D printing (also known as additive manufacturing or rapid prototyping) refers to a variety of technologies and processes that manufacture complex parts layer by layer from a 3D computer-aided design (CAD) model. As an additive technology, 3D printing processes build models by adding stacks of materials and fusing the layers together into a 3D object.…”

“…Through the development of 3D printed anatomic models and patient-specific surgical guides, this technological duo has led to more efficient and accurate surgeries improving outcomes. 5 6 7 8 9 10…”