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Facial Gender-Affirming Surgery: Frontal Bossing Surgical Techniques, Outcomes and Safety

  • Original Article
  • Facial Surgery
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Aesthetic Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Facial gender-affirming surgery (FGAS) is described as a set of surgical procedures done to feminize the soft tissue and the facial skeleton, allowing for transfeminine individuals to be recognizable as women to others. It is established in the literature that the most significant facial area for determination of gender is the forehead (Spiegel in Laryngoscope 121:250–261, 2011). This article describes the author’s three main surgical techniques used in forehead feminization and reports on the results.

Methods

The type of surgery performed is based on the patient’s anatomy. Type one FGAS consists of burring the anterior table of the frontal bone and is done when frontal bossing is very minimal. Type two FGAS includes burring and applying hydroxyapatite to contour the forehead and is done when frontal bossing is moderate. Type three surgery includes anterior table osteotomy, repositioning and fixation with a non-resorbable titanium plate and is performed for more severe frontal bossing.

Results

We present three techniques to feminize the forehead based on patient anatomy, modifying Ousterhout’s methods with the use of hydroxyapatite and titanium plates. Complications were rare and consisted of hematoma (1%), chronic sinusitis (1%), cicatricial alopecia (3%), hardware palpability (5%) and delayed wound healing (6%). Ninety-five percent of patients reported being satisfied/highly satisfied with their cosmetic outcome.

Conclusions

FGAS plays an important role in the treatment for gender dysphoria, offering transfeminine individuals an improvement in their self-esteem and quality of life. In our series of 100 cases, we demonstrate good esthetic outcomes with a low complication rate.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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Acknowledgements

Natasha Guérard-Poirier.

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Authors and Affiliations

  1. Departement de Chirurgie Plastique, Université de Montréal, Montréal, QC, Canada

    Michelle Bonapace-Potvin, Megan Pepin, Pauline Navals, Maria Cassandre Medor, Elisabeth Lorange & Éric Bensimon

  2. Clinique Dr Bensimon, 1003 Boul St-Joseph Est, Montréal, QC, H2J1L2, Canada

    Michelle Bonapace-Potvin

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  1. Michelle Bonapace-Potvin
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Correspondence to Michelle Bonapace-Potvin.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The individuals depicted in the photographs provided written informed consent to having their images used for the purpose of this article.

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Bonapace-Potvin, M., Pepin, M., Navals, P. et al. Facial Gender-Affirming Surgery: Frontal Bossing Surgical Techniques, Outcomes and Safety. Aesth Plast Surg 47, 1353–1361 (2023). https://doi.org/10.1007/s00266-022-03180-3

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