Sinocutaneous Fistula: A Long-term Complication After Surgical Feminization of the Forehead

Facial feminization surgery is part of the process of treating patients with gender dysphoria. Forehead contouring, a common part of facial feminization surgery, modifies masculine facial features of the upper third, especially decreasing the thickness of their frontal sinuses and the orbital bossing. Forehead contouring is considered a safe procedure with minor complications and high patient satisfaction. However, rare cases of sinocutaneous fistula have been reported as long-term complications. The diagnosis and therapeutic management of this complication are challenging. Therefore, the authors report a case of frontal sinocutaneous fistula occurring 2 years and 10 months after forehead contouring with its clinical presentation and treatment modalities. Surgeons practicing forehead contouring and patients undergoing this procedure should be aware of the risk of sinocutaneous fistula, a rare but severe complication that requires multidisciplinary medico-surgical care.