Facial Feminization Surgery in the Era of 3D Planning

Objectives: DSM-V defines gender dysphoria as a marked incongruence between one’s experienced/expressed gender and assigned gender. This condition is associated with clinically significant distress in social or other important areas of functioning. Therefore, Gender confirmation surgery is an essential component in helping individuals alleviate gender dysphoria. Facial feminization surgery encompasses a broad range of craniomaxillofacial surgical procedures designed to change masculine facial features into feminine features.

Methods: Virtual surgical planning (VSP) has been demonstrated in craniofacial applications to reduce operating room times and improve reconstructive outcomes. Generation of pre-fabricated cutting guides allows for rapid design and precise execution of osteotomies. We have utilized VSP for pre-operative planning and production of intra-operative cutting guides. Using the patient’s pre-operative computed tomography (CT) scanning, via 3D planning software (Synergy3DMed) we were able to pre-plan our osteotomies and produce accurate cutting guides for osteotomy of the anterior table of the frontal sinus, reduction of mandibular angles and chin reduction.

Results: Using the pre-fabricated cutting guide for the anterior table of the frontal sinus we reduced the risk of intracranial injury, allowed for maximal bone preservation, and rapidly repositioned and fixated the anterior table. The cutting guides for the mandibular angles and chin osteotomies enabled symmetrical bilateral bone reduction with reduced operating time and maximal esthetic results.

Conclusion: Virtual surgical planning for facial feminization surgery reduces operating room time, decreases the risk for intra- and post-operative complications and improves reconstructive and esthetic outcomes.