Facial masculinization surgery

Facial masculinization surgery (FMS) is a set of plastic surgery procedures that can transform the patient’s face to exhibit typical masculine morphology. Cisgender men may elect to undergo these procedures, and in the context of transgender people, FMS is a type of facial gender confirmation surgery (FGCS), which also includes facial feminization surgery (FFS) for transgender women.[1]

FMS can include various bony procedures such as chin augmentation, cheek augmentation, as well as augmentation of the forehead, jaw, and Adam's apple. In FMS, most procedures involve "having structures added to give more angles to the face."[2]

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History

Trans men have requested FMS procedures since the 20th century.[3] FMS is currently less common than FFS.[4] Urologist Miriam Hadj-Moussa notes that "transgender men rarely undergo facial masculinization surgery since testosterone therapy leads to growth of facial hair and makes it easier for them to present."[5]

In 2011, Douglas Ousterhout outlined the available FMS procedures, drawing on the work of Paul Tessier.[6] In 2015 Shane Morrison published an overview of all gender confirming surgeries for trans men, including FMS.[7] In 2017, Ousterhout's successor Jordan Deschamps-Braly published a case report on the first female-to-male facial confirmation surgery that included masculinization of the Adam's apple.[8]

According to the World Professional Association for Transgender Health, for many transgender men, FMS is considered medically necessary to treat gender dysphoria.[9][10]

Following the WPATH recommendations, several literature reviews and summaries of the state of the art were published.[11][12][13][14]

Surgical procedures

The surgical procedures most frequently performed during FMS often include facial implants and include the following, as outlined in a special 2018 issue of Clinics in Plastic Surgery edited by Loren Schechter and Bauback Safa.[15]

Forehead augmentation

Forehead augmentation can be done with a customized implant, or with injected materials that are molded into shape before they harden.[16]

Jaw augmentation

Orthognathic surgery was first performed for functional reasons in the late 19th century, with cosmetic procedures being improved and refined throughout the 20th century.[17] It is performed with fillers or customized implants.

Chin augmentation

Chin augmentation, also called a mentoplasty or genioplasty, is performed with fillers or customized implants. It can also be performed with an osteotomy plus an implant made of alloplastic materials like Proplast I, Proplast II, and porous block hydroxyapatite.[18] </ref>

Adam's apple augmentation

This newer procedure uses an implant made from cartilage taken from the patient’s rib cage.[8]

See also

References
  1. Deschamps-Braly, JC (2018). "Facial Gender Confirmation Surgery". Clinics in Plastic Surgery. 45 (3): 323–331. doi:10.1016/j.cps.2018.03.005.
  2. Yarbrough E (2018). Transgender Mental Health. American Psychiatric Association Publishing. ISBN 9781615371136
  3. Ng EM (1999). Sexuality in the New Millennium: Proceedings of the 14th World Congress of Sexology, Hong Kong SAR, China, August 23-27, 1999. Compositori ISBN 9788877942296
  4. Colebunders B, D’Arpa S, Weijers S, Lumen N, Hoebeke P, Monstrey S (2016). Female-to-Male Gender Reassignment Surgery. In Ettner R, Monstrey S, Coleman E, Eds. Principles of Transgender Medicine and Surgery. Routledge ISBN 9781317514602
  5. Hadj-Moussa, M; Agarwal, S; Ohl, DA; Kuzon, WM (2019). "Masculinizing Genital Gender Confirmation Surgery". Sexual Medicine Reviews. 7 (1): 141–155. doi:10.1016/j.sxmr.2018.06.004.
  6. Ousterhout, DK (2011). "Dr. Paul Tessier and Facial Skeletal Masculinization:". Annals of Plastic Surgery. 67 (6): S10–S15. doi:10.1097/SAP.0b013e31821835cb.
  7. Morrison, SD; Perez, MG; Nedelman, M; Crane, CN (2015). "Current State of Female-to-Male Gender Confirming Surgery". Current Sexual Health Reports. 7 (1): 38–48. doi:10.1007/s11930-014-0038-2.
  8. Deschamps-Braly, JC; Sacher, CL; Fick, J; Ousterhout, DK (2017). "First Female-to-Male Facial Confirmation Surgery with Description of a New Procedure for Masculinization of the Thyroid Cartilage (Adam's Apple):". Plastic and Reconstructive Surgery. 139 (4): 883e–887e. doi:10.1097/PRS.0000000000003185.
  9. World Professional Association for Transgender Health (2016). Position Statement on Medical Necessity of Treatment, Sex Reassignment, and Insurance Coverage in the U.S.A. Page accessed September 8, 2018
  10. World Professional Association for Transgender Health. Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People, Version 7. Archived 2015-08-14 at the Wayback Machine pg. 58 (2012).
  11. Berli, JU; Capitán, L; Simon, D; Bluebond-Langner, R; Plemons, E; Morrison, SD (2017). "Facial gender confirmation surgery—review of the literature and recommendations for Version 8 of the WPATH Standards of Care". International Journal of Transgenderism. 18 (3): 264–270. doi:10.1080/15532739.2017.1302862.
  12. Capitán, L; Simon, D; Berli, JU; Bailón, C; Bellinga, RJ; Santamaría, JG; Tenório, T; Sánchez-García, A; Capitán-Cañadas, F (2017). "Facial Gender Confirmation Surgery: A New Nomenclature". Plastic and Reconstructive Surgery. 140 (5): 766e–767e. doi:10.1097/PRS.0000000000003798.
  13. Morrison, SD; Chen, ML; Crane, CN (2017). "An overview of female-to-male gender-confirming surgery". Nature Reviews Urology. 14 (8): 486–500. doi:10.1038/nrurol.2017.64.
  14. Massenburg, BB; Morrison, SD; Rashidi, V; Miller, C; Grant, DW; Crowe, CS; Velasquez, N; Shinn, JR; Kuperstock, JE; Galaiya, DJ; Chaiet, SR; Bhrany, AD (2018). "Educational Exposure to Transgender Patient Care in Otolaryngology Training:". Journal of Craniofacial Surgery. 29 (5): 1252–1257. doi:10.1097/SCS.0000000000004609.
  15. Schechter LS, Safa B, Eds. (2018). Gender Confirmation Surgery. Clinics in Plastic Surgery. Volume 45, Issue 3, Pages 295-446 (July 2018). ISBN 9780323610742
  16. Park, DK; Song, I; Lee, JH; You, YJ (2013). "Forehead Augmentation with a Methyl Methacrylate Onlay Implant Using an Injection-Molding Technique". Archives of Plastic Surgery. 40 (5): 597. doi:10.5999/aps.2013.40.5.597.
  17. Puricelli, E (2007). "A new technique for mandibular osteotomy". Head & Face Medicine. 3 (1): 15. doi:10.1186/1746-160X-3-15.
  18. Moenning, JE; Wolford, LM (1989). "Chin augmentation with various alloplastic materials: a comparative study". International Journal of Adult Orthodontics and Orthognathic Surgery. 4 (3): 175–187. PMID 2561746.
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