Capitán Luis, Simon Daniel, Kaye Kai, Tenorio Thiago
Marbella, Málaga, Spain From the MHC International Hospital, Facial Team Surgical Group.
Plast Reconstr Surg. 2014 Oct;134(4):609-619. doi: 10.1097/PRS.0000000000000545.
Facial feminization surgery encompasses a series of surgical techniques derived from plastic and craniomaxillofacial surgery to soften facial features that are generally perceived as being more masculine, mainly in patients diagnosed with gender dysphoria. This article describes the main surgical techniques used in feminization of the forehead complex, sequences the different steps in forehead reconstruction, evaluates results obtained using cephalometric analysis, and includes the level of patient satisfaction.
Between January of 2008 and December of 2012, the authors performed a total of 172 forehead operations. The postsurgical results were analyzed using postoperative cephalometric studies that were compared with preoperative teleradiographies. The patients' level of satisfaction was also evaluated using a satisfaction questionnaire that they filled out after a 6-month postoperative period.
Along with an evaluation of patient satisfaction and clinical and cephalometric results where significant setback of the frontal bossing was observed, the authors present the sequencing of frontonasal-orbital reconstruction/recontouring with systematic osteotomy of the anterior wall of the frontal sinus in addition to developing a modification of the standard coronal approach.
By treating the forehead region with the different surgical procedures described in this article, masculine facial features of the upper third can be modified with predictable and satisfactory results. Facial feminization surgery must be considered part of the process of treating patients with gender dysphoria, because the modification and elimination of masculine facial features allows these patients to adapt more easily to the workplace and social and family environments.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
面部女性化手术包含一系列源自整形和颅颌面外科手术的技术，用于柔化通常被认为更具男性特征的面部容貌，主要针对被诊断为性别焦虑症的患者。本文描述了前额复合体女性化所使用的主要手术技术，梳理了前额重建的不同步骤，评估了通过头影测量分析获得的结果，并纳入了患者满意度水平。
在2008年1月至2012年12月期间，作者共进行了172例前额手术。术后结果通过术后头影测量研究进行分析，并与术前远距离X线摄影进行比较。患者的满意度也通过他们在术后6个月填写的满意度问卷进行评估。
除了评估患者满意度以及临床和头影测量结果（观察到额部隆起明显消退）外，作者还展示了鼻眶部重建/重塑的顺序，包括额窦前壁的系统性截骨，此外还对标准冠状入路进行了改良。
通过本文所述的不同手术方法治疗前额区域，可以改善上三分之一面部的男性化特征，获得可预测且令人满意的结果。面部女性化手术必须被视为治疗性别焦虑症患者过程的一部分，因为对男性化面部特征的改变和消除能使这些患者更容易适应工作场所、社会和家庭环境。
临床问题/证据级别：治疗性，IV级。
