Facial Feminization Surgery (FFS) includes several procedures designed to give the face a more feminine and harmonious appearance. Feminizing procedures such as hairline lifts, brow lifts, rhinoplasty, chin augmentation, and chondrolaryngoplasty, also known as “tracheal shaving,” provide definition and eliminate sources of ongoing misgendering for the patient.
The upper third of the face is an important area to treat in FFS, and surgeons at UCSF have quantified the results of brow lift and hair growth in a study published on December 29, 2022 in Facial Plastic Surgery & Aesthetic Medicine.
Feminization of the eyebrows, hairline, and forehead in trans women undergoing gender-affirming facial surgery was measured in photographs and aided in patient counseling and surgeon outcome monitoring.
In the study, pre- and postoperative frontal photographs were subjected to computer-assisted photo analysis. Eyebrow position, hairline position, and forehead height were measured.
Patient self-identifications, race, ethnicity, and other demographic factors were also collected.
Forty-six patients underwent FFS with brow lift and hairline elevation with photometric measurement permitting. Brow analysis was performed on 33 patients. Hairline and forehead analyzes were performed on 30 patients. In the study patient series, the forehead was successfully lifted at all points, and hairlines and forehead height were significantly reduced. On average, 4-5 mm of brow lift, 6-7 mm of hairline lowering and 10-11 mm of forehead reduction were achieved, contributing to a more feminine appearance of the upper third of the face.
These transformations together created a more feminine appearance in the upper third of the face and are thought to play a particularly important role in determining facial gender perception.
“These types of surgeries can be life-changing for patients with gender dysphoria,” he said P. Daniel Knott, MD, FACS, professor and director of facial cosmetic and reconstructive surgery in the UCSF Department of Otolaryngology-Head and Neck Surgery. “Psychological distress results from the discrepancy between the sex assigned at birth and the internal gender identity.”
Reliable objective measures of surgical outcome are beneficial for counseling patients and for critically evaluating surgeon outcomes. These measures will likely improve with the advancement and increased accessibility of 3D facial scanning technology.
Authors: Abel P. David, MD; Adrian E. House, MD; Sonia Targ, MS; Andrea M. Park, MD; Rahul Seth, MD; and P. Daniel Knott, MD
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