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Updated: Jun 24, 2025

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The Nasoorbitofrontal Complex in Facial Feminization Surgery.

Tristan Beaufils1, Yanis Berkane1,2,3,4, Vlad Luca-Pozner5,6

  • 1From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Rennes University Hospital Center.

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|June 10, 2024
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Summary

Single-stage nasoorbitofrontal (NOF) complex reshaping is effective for facial feminization surgery, showing significant craniometric changes and higher patient satisfaction. This approach offers predictable results for the upper face in gender-affirming care.

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Area of Science:

  • Plastic Surgery
  • Gender-Affirming Care
  • Craniofacial Surgery

Background:

  • Facial feminization surgery (FFS) demand is rising, necessitating reliable techniques for upper facial enhancement.
  • The nasoorbitofrontal (NOF) complex is a key area for feminization.
  • Evaluating single-stage NOF complex reshaping is crucial for improving FFS outcomes.

Purpose of the Study:

  • To assess the effectiveness of single-stage nasoorbitofrontal (NOF) complex reshaping in facial feminization surgery.
  • To compare outcomes between orbitofrontal (OF) surgery and combined NOF surgery.
  • To evaluate patient satisfaction following these procedures.

Main Methods:

  • 155 transfeminine patients undergoing upper facial surgery were included.
  • Outcomes were compared between patients receiving OF surgery (65) and NOF surgery (90).
  • Preoperative and postoperative CT scans analyzed 2D anatomic angles; patient satisfaction was assessed using FACE-Q at 6 months.

Main Results:

  • Both OF and NOF surgeries yielded significant craniometric changes (P < 0.001).
  • The NOF group showed greater improvements in nasofrontal, frontal tilt, and metopion angles compared to the OF group.
  • The NOF group reported higher patient satisfaction (median 4/5) than the OF group (median 3/5). No early complications were noted.

Conclusions:

  • Single-stage NOF complex surgery is an effective method for upper facial gender-affirming surgery.
  • This approach provides predictable results and enhances patient satisfaction.
  • NOF complex reshaping is a valuable technique in feminizing the upper face.