Facial Plastic Surgery Clinics of North America

No abstract text is available yet for this article.

No abstract text is available yet for this article.

The shape and size of the chin are very important in feminizing the lower third of the face, and osseous genioplasty is commonly used in FFS. Different variations of the osseous genioplasty can be used to feminize the chin. The 1-piece genioplasty reduces the size and rounds the chin. 2-piece genioplasty reduces or increases the projection of the chin, but retains the same shape. 3-piece genioplasty also reduces or increases the projection, but has the additional benefit of narrowing the chin. This narrowing helps to create the "V" shaped lower face that is often desired by patients seeking facial feminization...

This article provides a brief cross-cultural history of transgender, nonbinary, and other diverse gender identities, before exploring the background of gender-affirming care and facial feminization surgery in the United States. A variety of techniques for feminization rhinoplasty are discussed in detail. The authors provide insight into assessment and counseling of this unique patient population, timing of surgery, functional nasal considerations, and performing rhinoplasty in the context of other facial feminization procedures...

Injectable treatments are valuable tools to be considered in those seeking facial gender-affirming therapies. As stand-alone procedures, they are unlikely to meet expectations, particularly in those seeking facial feminization. However, injectables can be useful for those seeking to transition into another gender role, who are not ready for more permanent surgical treatment. They are also useful to help fine-tune features to one's satisfaction. Transgender people in the United States are more likely than the general population to be impoverished, and thus the cost of injectables may be a more salient concern...

Cheek augmentation is frequently used in facial feminization surgery. Options for augmentation include both surgical and nonsurgical techniques, such as autologous and non-autologous injections, implants, and osteotomies. Cheek augmentation can be combined with other facial procedures. Complications of cheek augmentation include malposition, resorption, asymmetry, and unfavorable cosmetic results. Cheek augmentation should be considered as part of an overall facial feminizing plan.

For patients with gender dysphoria, gender-affirming surgery of the face has been shown to vastly improve quality of life. The mandible is one area of the face that has distinct feminine and masculine presentations. This article will review gender-affirming surgery of the lower jaw, both for feminization and masculinization. Techniques for bony contouring and soft tissue manipulation will be discussed.

Hair restoration can play an important role for transgender patients seeking gender-affirmation procedures. In our clinic, we have seen an increase in transgender patients seeking hair restoration. The most common hair restoration procedures performed in our clinic for the transgender patient are hairline lowering procedures, facial hair restoration procedures including eyebrow and beard transplantation, and body hair transplantation.

Insurance coverage of gender-affirming surgeries including facial and vocal feminization surgery remains a challenge for many patients, physicians, and practice administrators. These challenges range from disparities in coverage for commercial versus public insurance carriers, in network versus out of network benefits, preauthorization struggles, and the lack of standard coverage policies. This article aims to describe the insurance coverage and approval challenges related to facial feminization surgery and to provide guidance for surgeons and their practice administrators on how to obtain successful preauthorization/predetermination, single case agreements, and proper claim adjudication...

The upper third of the face has an important effect on gendering patients. Forehead contouring modifying a masculine face to a more feminine form is most likely to affect the gender assessment of an individual's face. Contouring involves techniques such as forehead reduction or augmentation, orbital contouring, and hairline adjustment. Traditionally, surgeons have utilized an open technique, though newer innovations such as endoscopic procedures and custom implants provide an alternative for patients with mild defects...

Chondrolaryngoplasty is a surgical procedure that reduces the prominence of the thyroid notch. Although frequently performed on transgender (man to woman) women, anyone wishing to reduce the prominence of their thyroid notch for aesthetic purposes may consider undergoing a chondrolaryngoplasty. Direct visualization of the vocal cords with flexible laryngoscopy and intraoperative needle localization of the anterior commissure directs the extent of resection, helps increase safety, and avoids devastating postoperative voice complications...

Preparing for facial feminization surgery (FFS) or gender-affirming facial surgery is a daunting task. Patients do extensive research online to see what FFS means. Oftentimes it is the patients who are educating their physicians when discussing medical clearance or the esteemed "therapy letter." The therapy letter is a letter that details the support for surgery in a stable patient and reaffirms the need to have FFS in a person diagnosed with gender dysphoria. This typically follows the World Professional Association for Transgender Health standards-of-care guidelines...

There are anthropometric differences between the bony and integumentary facial features of male and female individuals. When compared to males, female faces in general are more heart-shaped, with a shorter and smoother forehead, a smaller more defined nose, and a tapered chin.

No abstract text is available yet for this article.

It is important to understand the legal malpractice risks and strategies to reduce them in facial plastic surgery. Cosmetic procedures and the use of social media introduces additional risks that should be considered by practicing facial plastic surgeons. Strategies should be implemented to protect yourself and your patients, which include an emphasis on informed consent as it relates to using photos on social media platforms, removing photos from social media, and addressing online reviews. By understanding the risks and using adequate strategies, facial plastic surgeons can minimize the risk of litigation when performing cosmetic procedures...

Aging patients and outpatient settings add complexity to the anesthetic management of facial plastic surgery, which emphasizes a quiet surgical field and smooth perioperative journey, absent rocky emergence phenomena, postoperative nausea and vomiting, prolonged post-anesthesia care unit stays, or last-minute hospital admissions. Monitored anesthesia care can be ideal with proper patient selection and a conscientious provider, although overlooking potential risks has led to catastrophic consequences, including burns, hypoxic brain injury, and death...

Panfacial trauma refers to injuries caused by high-energy mechanisms to two or more regions of the craniofacial skeleton, including the frontal bone, the midface, and the occlusal unit. As with any trauma, Advanced Trauma Life Support protocols should be followed in unstable patients. For the patient with panfacial traumatic injury, advanced perioperative care or critical care is frequently required. This article describes surgical critical care for panfacial injuries, a component of the acute-care surgery model, to reduce systemic risks, improve the patient's condition, and enable a successful surgical outcome...

The midface skeleton provides structural scaffolding to the middle third of the face. Complications associated with fracture repair in these regions can result from incomplete, inaccurate, or delayed assessment, poor initial and subsequent reduction and fixation, infection, uncontrolled hemorrhage, hardware failure and associated soft tissue injuries. A systematic approach to managing the patient with facial trauma that includes Acute Trauma Life Support principles, early reconstruction, and precise reduction and fixation is essential to reducing the short-term and long-term risks of complications...

Facial reanimation surgery can greatly improve quality of life, but these procedures are not without risk. Important considerations for risk reduction in facial reanimation surgery include preoperative risk-stratification, protecting patients' clinical media, clearly and thoroughly setting expectations, and intraoperative strategies to maximize technical success and minimize operative time.

Facial skin defects pose unique challenges for the reconstructive surgeon. Aesthetically complex areas involving a free margin-such as the ear, eyelid, columella, columella-lobule interface, soft tissue triangle, alar rim, and internal nasal lining-are particularly demanding, as secondary soft tissue contracture in these locations can lead to a very poor cosmetic outcome. In these cases, composite grafts offer an ideal combination of soft tissue coverage and structural rigidity, all accomplished in a single-stage surgery...