XV Harry Benjamin International Gender Dysphoria Association Symposium

The State of Our Art and the State of Our Science

Gender confirming facial surgery. Part II
Indications and results

By D Bram Tuinzing, DMD, PhD*; Alfred G Becking, DDS, MD*; J Joris Hage, MD⁺
*Department of Oral and Maxillofacial Surgery
⁺Department of Plastic and Reconstructive Surgery, Free University Hospital
POBox 7057, 1007 MB Amsterdam, The Netherlands
Abstract

In the period 1992-1996, 46 male-to-female transsexuals were referred for possible bony facial corrections as gender confirming procedures of the face. In 11 cases, patients’ expectations and surgical possibilities did not match. In the remaining 35 patients 45 surgical facial procedures were performed. Of the 35 patients 29 patients had undergone genital reassignment while in 5 this was scheduled.

Over the years different techniques were developed for feminizing a male face. Mandibular angle reduction (n=23) is carried out to reduce the lower facial width. Chin reduction procedures (n=14) are performed to 3 dimensionally reduce the masculine , prominent bony chin. Zygoma onlay or zygoma osteotomies (n=3) increase the mid-facial width. Bimaxillary osteotomies (n=3) with dorsal impaction and clockwise rotation of the bimaxillary complex decrease the projection of both the chin and the mandibular angle region. Reduction of the supraorbital prominence (n=2) leads to less frontal bossing and a more obtuse naso-frontal angle, both are considered feminine. The latter technique can easily be combined with a browlift procedure and thus feminize the curvature and position of the eyebrows.

Rhinoplasty was performed separately in 21 patients with nasal osteotomies and tip surgery to correct the different angles of the nose toward a more feminine appearance.

In selecting male-to-female transsexuals good results were obtained with gender-confirming facial surgery. Stability of the results, psychosocial aspects and improvement of quality of life need further evaluation.