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The Type I+ Forehead in Facial Feminization Surgery.

Shahrzad Moghadam¹, Kaavian Shariati¹, Kelly X Huang¹

¹Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine, University of California, 200 Medical Plaza Suite 460, Los Angeles, CA, 90095-6960, USA.

Aesthetic Plastic Surgery

|September 18, 2024

Summary

A new Type I+ technique for feminizing fronto-orbital reconstruction addresses intermediate frontal sinus morphologies. This method is effective for patients with shallower sinuses and thicker anterior tables, offering a tailored approach in facial feminization surgery.

Keywords:

Facial feminization surgery Facial gender-affirming surgery Feminizing forehead reconstruction Gender-affirming facial surgery

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Area of Science:

Plastic Surgery
Facial Feminization Surgery
Craniofacial Reconstruction

Background:

Feminizing fronto-orbital reconstruction typically uses Ousterhout Type III or Type I techniques.
An intermediate morphology with frontal sinuses, moderately thick anterior tables, or shallow sagittal plane sinuses requires a tailored approach.
The novel Type I+ technique combines frontal bone recontouring with anterior table reconstruction and split cranial bone grafts.

Purpose of the Study:

To introduce and describe the Type I+ fronto-orbital reconstruction technique.
To compare the Type I+ technique with the established Type III technique for feminizing fronto-orbital reconstruction.

Main Methods:

Retrospective review of transgender and gender non-conforming patients undergoing Type I+ or Type III feminizing fronto-orbital reconstruction (2019-2023).
Comparison of morphological characteristics and surgical outcomes between the two techniques.

Main Results:

123 patients were included; 6.5% underwent Type I+ and 94.5% Type III reconstruction.
Type I+ patients exhibited shallower frontal sinuses (median depth 4.1mm vs. 9.8mm) and thicker anterior tables (median 6.6mm vs. 2.2mm) compared to Type III patients.
Type I+ procedures involved less anterior table reduction (2.7mm vs. 4.2mm) than Type III procedures.

Conclusions:

The Type I+ technique offers a novel solution for intermediate frontal sinus phenotypes in facial feminization.
This technique provides a refined approach for patients not fitting standard Type I or Type III criteria.