Facial masculinization surgery

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Facial masculinization surgery (FMS) is a set of plastic surgery procedures that can transform the patient's face to exhibit typical masculine morphology. Cisgender men may elect to undergo these procedures, and in the context of transgender people, FMS is a type of facial gender confirmation surgery (FGCS), which also includes facial feminization surgery (FFS) for transgender women. [1]

Contents

FMS can include various bony procedures such as chin augmentation, cheek augmentation, as well as augmentation of the forehead, jaw, and Adam's apple. In FMS, most procedures involve "having structures added to give more angles to the face." [2]

History

Trans men have requested FMS procedures since the 20th century. [3] FMS is currently less common than FFS. [4] Urologist Miriam Hadj-Moussa notes that "transgender men rarely undergo facial masculinization surgery since testosterone therapy leads to growth of facial hair and makes it easier for them to present." [5]

In 2011, Douglas Ousterhout outlined the available FMS procedures, drawing on the work of Paul Tessier. [6] In 2015 Shane Morrison published an overview of all gender affirming surgeries for trans men, including FMS. [7] In 2017, Ousterhout's successor Jordan Deschamps-Braly published a case report on the first female-to-male facial confirmation surgery that included masculinization of the Adam's apple. [8]

According to the World Professional Association for Transgender Health (WPATH), for many transgender men, FMS is considered medically necessary to treat gender dysphoria. [9] [10] Following the WPATH recommendations, several literature reviews and summaries of the state of the art were published in 2017 and 2018. [11] [12] [13] [14]

Surgical procedures

The surgical procedures most frequently performed during FMS often include facial implants and include the following, as outlined in the literature. [6] [15] [16]

Forehead augmentation

The purpose of forehead augmentation is to create a less rounded forehead with a more prominent supraorbital ridge typical of cisgender men. It can be done with a customized implant, a calvarial bone graft, fat grafting, or materials such as bone cement that are molded into shape before they harden. Injectable fillers may also be used as an outpatient procedure. [6] [16] [17]

Jaw augmentation

Orthognathic surgery was first performed for functional reasons in the late 19th century, with cosmetic procedures being improved and refined throughout the 20th century. [18] In facial masculinization surgery, the goal is to create a more robust and square jaw with a sharper mandibular angle. This can be achieved through hydroxyapatite (bone mineral) grafts, which promote new bone growth, or through customized implants. [16]

Chin augmentation

To change the appearance of the jaw, chin augmentation may also be performed. This can consist of chin implants or an osteotomy to make the chin tip appear wider and more prominent. [16]

Adam's apple augmentation

This newer procedure uses an implant made from cartilage taken from the patient's rib cage to augment the tip of the thyroid cartilage known as the "Adam's apple." It was first performed in 2017. [8]

See also

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References

  1. ↑ Deschamps-Braly, JC (2018). "Facial Gender Confirmation Surgery". Clinics in Plastic Surgery. 45 (3): 323–331. doi:10.1016/j.cps.2018.03.005. PMID   29908620. S2CID   49266967.
  2. ↑ Yarbrough E (2018). Transgender Mental Health. American Psychiatric Association Publishing. ISBN   9781615371136
  3. ↑ Ng EM (1999). Sexuality in the New Millennium: Proceedings of the 14th World Congress of Sexology, Hong Kong SAR, China, August 23–27, 1999. Compositori ISBN   9788877942296
  4. ↑ Colebunders B, D'Arpa S, Weijers S, Lumen N, Hoebeke P, Monstrey S (2016). Female-to-Male Gender Reassignment Surgery. In Ettner R, Monstrey S, Coleman E, Eds. Principles of Transgender Medicine and Surgery. Routledge ISBN   9781317514602
  5. ↑ Hadj-Moussa, M; Agarwal, S; Ohl, DA; Kuzon, WM (2019). "Masculinizing Genital Gender Confirmation Surgery". Sexual Medicine Reviews. 7 (1): 141–155. doi:10.1016/j.sxmr.2018.06.004. PMID   30122339. S2CID   52041826.
  6. 1 2 3 Ousterhout, DK (2011). "Dr. Paul Tessier and Facial Skeletal Masculinization". Annals of Plastic Surgery. 67 (6): S10–S15. doi:10.1097/SAP.0b013e31821835cb. PMID   22123544. S2CID   2985782.
  7. ↑ Morrison, SD; Perez, MG; Nedelman, M; Crane, CN (2015). "Current State of Female-to-Male Gender Confirming Surgery". Current Sexual Health Reports. 7 (1): 38–48. doi:10.1007/s11930-014-0038-2. S2CID   73246160.
  8. 1 2 Deschamps-Braly, JC; Sacher, CL; Fick, J; Ousterhout, DK (2017). "First Female-to-Male Facial Confirmation Surgery with Description of a New Procedure for Masculinization of the Thyroid Cartilage (Adam's Apple)". Plastic and Reconstructive Surgery. 139 (4): 883e–887e. doi:10.1097/PRS.0000000000003185. PMID   28350659. S2CID   25766890.
  9. ↑ World Professional Association for Transgender Health (2016). Position Statement on Medical Necessity of Treatment, Sex Reassignment, and Insurance Coverage in the U.S.A. Page accessed September 8, 2018
  10. ↑ World Professional Association for Transgender Health. Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People, Version 7. Archived 2015-08-14 at the Wayback Machine pg. 58 (2012).
  11. ↑ Berli, JU; Capitán, L; Simon, D; Bluebond-Langner, R; Plemons, E; Morrison, SD (2017). "Facial gender confirmation surgery—review of the literature and recommendations for Version 8 of the WPATH Standards of Care". International Journal of Transgenderism. 18 (3): 264–270. doi:10.1080/15532739.2017.1302862. S2CID   151530474.
  12. ↑ Capitán, L; Simon, D; Berli, JU; Bailón, C; Bellinga, RJ; Santamaría, JG; Tenório, T; Sánchez-García, A; Capitán-Cañadas, F (2017). "Facial Gender Confirmation Surgery: A New Nomenclature". Plastic and Reconstructive Surgery. 140 (5): 766e–767e. doi:10.1097/PRS.0000000000003798. PMID   28753146.
  13. ↑ Morrison, SD; Chen, ML; Crane, CN (2017). "An overview of female-to-male gender-confirming surgery". Nature Reviews Urology. 14 (8): 486–500. doi:10.1038/nrurol.2017.64. PMID   28508877. S2CID   20532197.
  14. ↑ Massenburg, BB; Morrison, SD; Rashidi, V; Miller, C; Grant, DW; Crowe, CS; Velasquez, N; Shinn, JR; Kuperstock, JE; Galaiya, DJ; Chaiet, SR; Bhrany, AD (2018). "Educational Exposure to Transgender Patient Care in Otolaryngology Training". Journal of Craniofacial Surgery. 29 (5): 1252–1257. doi:10.1097/SCS.0000000000004609. PMID   29771846. S2CID   21696185.
  15. ↑ Schechter LS, Safa B, Eds. (2018). Gender Confirmation Surgery. Clinics in Plastic Surgery. Volume 45, Issue 3, Pages 295-446 (July 2018). ISBN   9780323610742
  16. 1 2 3 4 Harris, Jason; Premaratne, Ishani D.; Spector, Jason A. (2021-10-01). "Facial Masculinization from Procedures to Payment: A Review". LGBT Health. 8 (7): 444–453. doi:10.1089/lgbt.2020.0128. ISSN   2325-8292. PMID   34403627. S2CID   237197450.
  17. ↑ Park, DK; Song, I; Lee, JH; You, YJ (2013). "Forehead Augmentation with a Methyl Methacrylate Onlay Implant Using an Injection-Molding Technique". Archives of Plastic Surgery. 40 (5): 597–602. doi: 10.5999/aps.2013.40.5.597 . PMC   3785596 . PMID   24086816.
  18. ↑ Puricelli, E (2007). "A new technique for mandibular osteotomy". Head & Face Medicine. 3 (1): 15. doi: 10.1186/1746-160X-3-15 . PMC   1845144 . PMID   17355642.
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