Reductive Genioplasty for Facial Feminization Surgery

Genioplasty is a crucial component of facial feminization surgery since feminine chins are noticeably narrower, with a more rounded appearance than masculine chins. This is traditionally achieved with a central wedge excision and a two-piece genioplasty segment that is then fixated. A reductive genioplasty with in situ bilateral ostectomies to narrow the chin can eliminate the need for rigid fixation while still providing a feminine appearance. This study analyzed 178 patients from January 2020 to July 2024. Patients were categorized into three-piece with plating or in situ reductive genioplasties. Both techniques were performed according to virtual surgical planning (VSP) guides. There were 136 patients (72.3%) in the plating group and 42 patients (22.3%) in the reductive group. The plating group had 10 cases of abscess (7.4%) and 2 cases of osteomyelitis (1.5%), whereas the in situ reductive group did not have any cases of abscess or osteomyelitis. HIV status was not a significant determinant of whether a patient developed infection. Both groups had one instance of hematoma. The plating group had 17 patients (12.5%) undergo revision surgery for asymmetry, hardware removal, or other reasons, while the in situ reductive group had no patients undergo revision surgery ( P  = 0.008). In situ reductive genioplasty may be a better alternative to the central wedge excision and two-piece ostectomy with fixation genioplasty for facial feminization surgery, as it results in fewer post-operative complications and greater patient satisfaction.