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Related Experiment Video

Updated: Jul 4, 2026

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Racial and Regional Differences of the Cheek for Facial Feminization: A Systematic Review.

Diane Saab1,2, Essie Ghafoor1, Madyson Brown1

  • 1Department of Plastic and Reconstructive Surgery, Center for Transgender and Gender Expansive Health, Johns Hopkins University, Baltimore, MD.

The Journal of Craniofacial Surgery
|July 3, 2026
PubMed
Summary

Males consistently have wider bizygomatic width (BW) than females across races and regions. Incorporating race and region into surgical planning optimizes facial feminization outcomes, preserving ethnic traits.

Keywords:
Bizygomatic widthfacial feminizationmaxillofacial surgerysexual dimorphism

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Area of Science:

  • Plastic Surgery
  • Anthropometry
  • Forensic Anthropology

Background:

  • Limited data exists on sexual dimorphism in malar dimensions across diverse populations.
  • Establishing quantitative norms for midface measurements is crucial for facial feminization surgery.
  • Preoperative planning requires sex, race, and region-specific data for optimal surgical outcomes.

Purpose of the Study:

  • To provide malar dimension measures specific to sex, race, and region for facial feminization surgery.
  • To conduct a systematic review and meta-analysis of midface measurements.
  • To aid in preoperative planning for facial feminization procedures.

Main Methods:

  • Systematic review and meta-analysis adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
  • Inclusion of 24 studies with a total of 11,122 patients (51.5% female).
  • Analysis of midface measurements, including bizygomatic width (BW) and soft-tissue thickness over the zygoma.

Main Results:

  • Significant sexual dimorphism in bizygomatic width (BW) was observed across racial groups and regions, with males exhibiting larger BWs.
  • Multivariate regression models showed that race and region combined best predicted BW variability in both males (71%) and females (82%).
  • Data on soft-tissue thickness overlying the zygoma was limited.

Conclusions:

  • Accounting for both race and region in malar facial feminization surgery planning can optimize results and preserve ethnic characteristics.
  • Consideration of facial height sexual dimorphism is important for adjusting BW to maintain race-specific proportions.
  • Further research into overall facial anatomy is needed to contextualize surgical implications of BW findings.