All patients received a setback of the anterior table of the frontal sinus (mean 4.3 ± 1.6 mm), 75.0% (n = 6) received reduction genioplasties, and 50.0% (n = 4) received bilateral gonial angle reductions. The mean length of the patients’ hospital stay was 1.5 ± 0.5 days, and the mean follow-up period was 115.3 ± 107.8 days. The mean age of the patients at the time of surgery was 32.3 ± 11.5 years, and the mean operative time was 8.7 ± 1.6 hours. RESULTSĮight patients underwent virtual modeling using a female skull for planning and execution of FFS ( Table 1 and Fig.

When necessary, bony step-offs were addressed with bone rasping or further resection. For the mandible, cutting guides were also designed to mark the amount of angle reduction. 3D printed cutting and positioning guides were used for the horizontal osteotomy and the central wedge excision. For the genioplasty, subperiosteal dissection was performed inferior to the mental fold and extended laterally to the inferior border of the mandible just below the mental foramina bilaterally. Two-piece reduction genioplasties and reduction of the gonial angles were approached intraorally through gingivobuccal incisions. Then, the anterior table of the frontal sinus was contoured and set back to the level of the newly contoured forehead. The frontal sinus cavity and nasofrontal ducts were inspected carefully to ensure patency before reconstruction of the anterior frontal sinus. The anterior table of the frontal sinus was osteotomized and precision forehead recontouring with reduction of the superior orbital rims occurred using virtually planned guides. Operative DetailsĪ pretrichial incision extending into the hairline laterally was carried out to expose the forehead. These were subsequently superimposed to identify the precise areas of reduction at the forehead (red dotted line), gonial angles (blue dotted line), and chin (yellow dotted line). On the left, 3D CT scans of the patient’s skull and the skull of the reference female are shown. Preoperative planning of the osseous maneuvers of facial feminization surgery was performed using a standard female skull as a reference. Modeling osseous maneuvers on a female skull. Custom cutting guides were 3D printed in preparation for the operation. Surgical maneuvers to correct discrepant skeletal areas between the patient and reference skull were then planned virtually. 1 and Video) ( see video, which displays virtual modeling for FFS). During the virtual planning session, patient skulls were superimposed on a female reference skull, which typically required proportional enlargement to the size of the patient’s skull ( Fig. VSP services were provided by 3D Systems (Rock Hill, S.C.). Fine-cut computed tomographic (CT) scans with a section thickness of 0.6 mm were obtained preoperatively in all patients. The clinical examination of the patients included measurements of the forehead length and the sagittal distance between the anterior globe and the most anterior portion of the forehead. Male-to-female transgender patients (n=8) undergoing primary FFS planned using virtual modeling on a female skull between 20 were included (UCLA IRB#11-000925).

In this work, we describe a method of simplifying FFS by virtually modeling surgery on a female skull. Thus, a powerful method of eliminating subjective guesswork in facial gender affirmation surgery is utilizing such a template to plan all surgical maneuvers. 7 In the context of FFS, the female skull is the perfect template. Using virtual modeling is now mainstream within the craniofacial community, typically for planning symmetrical osteotomies or designing custom implants. 5, 6 Thus, the margin for error is particularly narrow. Unlike congenital craniofacial reconstructive techniques focused on the restoration of normal anatomy, facial reconstruction for gender affirmation is focused on the conversion of normal masculine skeletal relationships to that of normal feminine relationships or vice versa. 1–4 However, similar to skeletal maneuvers of the craniofacial region, relative relationships are key to the success of a balanced and harmonious facial skeleton. Due to the extensive anatomic analyses of Ousterhout, concepts of precise clinical examination including measurements and cephalometric analyses translating to osseous surgical maneuvers have been well described. With the recent improvement in insurance coverage for FFS procedures, more patients are seeking FFS in the United States, leading to more craniofacial surgeons offering and performing these procedures. Facial feminization surgery (FFS) is one of the most important and dramatic surgical transitions for the treatment of gender dysphoria.

Surgeon perfect face template female