The Nasoorbitofrontal Complex in Facial Feminization Surgery

With the increasing demand for facial feminization surgery, there is a growing need for reliable and reproducible techniques to enhance outcomes. The authors aimed to evaluate the effectiveness of single-stage nasoorbitofrontal (NOF) complex reshaping in facial feminization surgery. Effectiveness was gauged by computed tomographic assessments and an unvalidated patient satisfaction survey at 6 months postoperatively.

The study included 155 transfeminine patients undergoing surgery of the upper third of the face. Outcomes were compared in patients receiving either orbitofrontal (OF) surgery or combined NOF surgery. A comparative analysis of preoperative and postoperative standardized computed tomography sections was performed, focusing on multiple anatomic angles in 2 dimensions. A self-administered satisfaction questionnaire based on 6 FACE-Q items was completed at 6 months.

Among the 155 patients, 65 underwent OF surgery and 90 underwent NOF surgery. The follow-up period ranged from 6 to 36 months, with an average follow-up of 18 months. Significant changes in craniometric measurements were observed. In the OF group, average changes in nasofrontal, frontal tilt, and metopion angles were +12.3 ± 0.2 degrees, -8.5 ± 2.2 degrees, and +20.0 ± 0.1 degrees, respectively ( P < 0.001); in the NOF group, they were +28.5 ± 0.3 degrees, -9.3 ± 2.4 degrees, and +23.9 ± 0.1 degrees, respectively ( P < 0.001). The NOF group demonstrated higher overall satisfaction (median, 4 of 5) compared with the OF group (median, 3 of 5). No early complications were reported.

The NOF complex surgery is an effective approach in gender-affirming surgery of the upper third of the face, yielding predictable results and higher patient satisfaction.

Therapeutic, III.