Simplifying Facial Feminization Surgery Using Virtual Modeling on the Female Skull

Abstract

Osseous work in facial feminization has been largely developed by comparing the qualitative and quantitative anthropometric differences between male and female cadaveric skulls. While virtual surgical planning has allowed for improved accuracy and ease in osteotomies and recontouring procedures in facial feminization, ultimately, a subjective decision-making process is still required. In this work, we describe a novel method of simplifying facial feminization by virtually modeling all osseous surgical maneuvers for facial feminization with a reference female skull.

Fig. 1.

Modeling osseous maneuvers on a female skull. Preoperative planning of the osseous maneuvers of facial feminization surgery was performed using a standard female skull as a reference. On the left, 3D CT scans of the patient’s skull and the skull of the reference female are shown. These were subsequently superimposed to identify the precise areas of reduction at the forehead (red dotted line), gonial angles (blue dotted line), and chin (yellow dotted line).

Fig. 2.

Preoperative and postoperative FFS results planned using virtual modeling on a female skull. Lateral preoperative (A) and postoperative (B) photographs of an FFS patient who underwent anterior table setback and forehead recontouring, hairline lowering, fat grafting to temple and malar areas, open reduction septorhinoplasty, two-piece reduction genioplasty, bilateral gonial angle reductions, and tracheal shave.