Facial masculinization surgery

Last updated

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

Related Research Articles

<span class="mw-page-title-main">Plastic surgery</span> Medical surgical specialty

Plastic surgery is a surgical specialty involving the restoration, reconstruction or alteration of the human body. It can be divided into two main categories: reconstructive surgery and cosmetic surgery. Reconstructive surgery includes craniofacial surgery, hand surgery, microsurgery, and the treatment of burns. While reconstructive surgery aims to reconstruct a part of the body or improve its functioning, cosmetic surgery aims at improving the appearance of it.

Gender-affirming surgery is a surgical procedure, or series of procedures, that alters a transgender person's physical appearance and sexual characteristics to resemble those associated with their identified gender. It is also known as sex reassignment surgery, gender confirmation surgery, and several other names.

<span class="mw-page-title-main">Skull</span> Bony structure that forms the head in vertebrates

The skull is a bone protective cavity for the brain. The skull is composed of four types of bone i.e., cranial bones, facial bones, ear ossicles and hyoid bone. However two parts are more prominent: the cranium and the mandible. In humans, these two parts are the neurocranium and the viscerocranium that includes the mandible as its largest bone. The skull forms the anterior-most portion of the skeleton and is a product of cephalisation—housing the brain, and several sensory structures such as the eyes, ears, nose, and mouth. In humans these sensory structures are part of the facial skeleton.

The Standards of Care for the Health of Transgender and Gender Diverse People (SOC) is an international clinical protocol by the World Professional Association for Transgender Health (WPATH) outlining the recommended assessment and treatment for transgender and gender-diverse individuals across the lifespan including social, hormonal, or surgical transition. It often influences clinicians' decisions regarding patients' treatment. While other standards, protocols, and guidelines exist – especially outside the United States – the WPATH SOC is the most widespread protocol used by professionals working with transgender or gender-variant people.

Facial feminization surgery (FFS) is a set of reconstructive surgical procedures that alter typically male facial features to bring them closer in shape and size to typical female facial features. FFS can include various bony and soft tissue procedures such as brow lift, rhinoplasty, cheek implantation, and lip augmentation.

Phalloplasty is the construction or reconstruction of a penis or the artificial modification of the penis by surgery. The term is also occasionally used to refer to penis enlargement.

Gender-affirming surgery for female-to-male transgender people includes a variety of surgical procedures that alter anatomical traits to provide physical traits more comfortable to the trans man's male identity and functioning.

Gender-affirming surgery for male-to-female transgender women or transfeminine non-binary people describes a variety of surgical procedures that alter the body to provide physical traits more comfortable and affirming to an individual's gender identity and overall functioning.

<span class="mw-page-title-main">Breast augmentation</span> Surgical procedure

Breast augmentation and augmentation mammoplasty is a cosmetic surgery technique using breast-implants and fat-graft mammoplasty techniques to increase the size, change the shape, and alter the texture of the breasts. Augmentation mammoplasty is applied to correct congenital defects of the breasts and the chest wall. As an elective cosmetic surgery, primary augmentation changes the aesthetics – of size, shape, and texture – of healthy breasts.

Douglas K. Ousterhout is a retired craniofacial surgeon who practiced in San Francisco, CA, United States. His specialty was facial feminization surgery for trans women, and he was widely considered the foremost facial feminization surgeon in the United States. Ousterhout also pioneered facial masculinization surgery for people undergoing female-to-male gender reassignment. Ousterhout received MD and DDS degrees from the University of Michigan Ann Arbor. He is a voluntary clinical professor of surgery in the School of Medicine and an adjunct professor of dentistry in the Dental School at University of California, San Francisco.

Chin augmentation using surgical implants can alter the underlying structure of the face, providing better balance to the facial features. The specific medical terms mentoplasty and genioplasty are used to refer to the reduction and addition of material to a patient's chin. This can take the form of chin height reduction or chin rounding by osteotomy, or chin augmentation using implants. Improving the facial balance is commonly performed by enhancing the chin using an implant inserted through the mouth. The goal is to provide a suitable projection of the chin as well as the correct height of the chin which is in balance with the other facial features.

<span class="mw-page-title-main">Scrotoplasty</span> Type of surgery to create or repair the scrotum

Scrotoplasty, also known as oscheoplasty, is a type of surgery to create or repair the scrotum. The history of male genital plastic surgery is rooted in many cultures and dates back to ancient times. However, scientific research for male genital plastic surgery such as scrotoplasty began to develop in the early 1900s. The development of testicular implants began in 1940 made from materials outside of what is used today. Today, testicular implants are created from saline or gel filled silicone rubber. There are a variety of reasons why scrotoplasty is done. Some transgender men and intersex or non-binary people who were assigned female at birth may choose to have this surgery to create a scrotum, as part of their transition. Other reasons for this procedure include addressing issues with the scrotum due to birth defects, aging, or medical conditions such as infection. For newborn males with penoscrotal defects such as webbed penis, a condition in which the penile shaft is attached to the scrotum, scrotoplasty can be performed to restore normal appearance and function. For older male adults, the scrotum may extend with age. Scrotoplasty or scrotal lift can be performed to remove the loose, excess skin. Scrotoplasty can also be performed for males who undergo infection, necrosis, traumatic injury of the scrotum.

<span class="mw-page-title-main">Frontal sinus</span>

The frontal sinuses are one of the four pairs of paranasal sinuses that are situated behind the brow ridges. Sinuses are mucosa-lined airspaces within the bones of the face and skull. Each opens into the anterior part of the corresponding middle nasal meatus of the nose through the frontonasal duct which traverses the anterior part of the labyrinth of the ethmoid. These structures then open into the semilunar hiatus in the middle meatus.

<span class="mw-page-title-main">Cheek augmentation</span> Cosmetic procedure intended to emphasize a persons cheeks

Cheek augmentation is a cosmetic surgical procedure that is intended to emphasize the cheeks on a person's face. To augment the cheeks, a plastic surgeon may place a solid implant over the cheekbone. Injections with the patients' own fat or a soft tissue filler, like Restylane, are also popular. Rarely, various cuts to the zygomatic bone (cheekbone) may be performed. Cheek augmentation is commonly combined with other procedures, such as a face lift or chin augmentation.

<span class="mw-page-title-main">Breast implant</span> Prosthesis used to change the size, shape, and contour of a persons breast

A breast implant is a prosthesis used to change the size, shape, and contour of a person's breast. In reconstructive plastic surgery, breast implants can be placed to restore a natural looking breast following a mastectomy, to correct congenital defects and deformities of the chest wall or, cosmetically, to enlarge the appearance of the breast through breast augmentation surgery.

Transgender hormone therapy, also called hormone replacement therapy (HRT) or gender-affirming hormone therapy (GAHT), is a form of hormone therapy in which sex hormones and other hormonal medications are administered to transgender or gender nonconforming individuals for the purpose of more closely aligning their secondary sexual characteristics with their gender identity. This form of hormone therapy is given as one of two types, based on whether the goal of treatment is masculinization or feminization:

The real-life experience (RLE), sometimes called the real-life test (RLT), is a period of time or process in which transgender individuals live full-time in their identified gender role in order to be eligible to receive gender-affirming treatment. The purpose of the RLE has been to confirm that a given transgender person could function successfully as a member of said gender in society, as well as to confirm that they are sure they want to live as said gender for the rest of their life. A documented RLE was previously a requirement of many physicians before prescribing gender-affirming hormone therapy, and a requirement of most surgeons before performing gender-affirming surgery.

Injectable filler is a soft tissue filler injected into the skin at different depths to help fill in facial wrinkles, provide facial volume, and augment facial features: restoring a smoother appearance. Most of these wrinkle fillers are temporary because they are eventually absorbed by the body. Most dermal fillers today consist of hyaluronic acid, a naturally occurring polysaccharide that is present in skin and cartilage. Some people may need more than one injection to achieve the wrinkle-smoothing effect. The effect lasts for about six months or longer. Successful results depend on health of the skin, skill of the health care provider, and type of filler used. Regardless of material filler duration is highly dependent on amount of activity in the region where it is injected. Exercise and high intensity activities such as manual labor can stimulate blood flow and shorten the lifespan of fillers.

<span class="mw-page-title-main">Sinus implant</span>

A Sinus implant is a medical device that is inserted into the sinus cavity. Implants can be in conjunction with sinus surgery to treat chronic sinusitis and also in sinus augmentation to increase bone structure for placement of dental implants.

Jordan Christopher Deschamps-Braly is an American maxillofacial and craniofacial surgeon specializing in facial gender-affirming surgery for transgender people. He co-developed a procedure for building a new Adam's apple for trans men and is known for his work as a plastic surgeon for trans women.

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.