Yahalom R, Blinder D, Nadel S
Refuat Hapeh Vehashinayim (1993). 2015 Jul;32(3):52-4, 70.
Transsexualism is a gender identity disorder in which there is a strong desire to live and be accepted as a member of the opposite sex. In male-to-female transsexuals with strong masculine facial features, facial feminization surgery is performed as part of the gender reassignment. A strong association between femininity and attractiveness has been attributed to the upper third of the face and the interplay of the glabellar prominence of the forehead. Studies have shown that a certain lower jaw shape is characteristic of males with special attention to the strong square mandibular angle and chin and also suggest that the attractive female jaw is smaller with a more round shape mandibular angles and a pointy chin. Other studies have shown that feminization of the forehead through cranioplasty have the most significant impact in determining the gender of a patient. Facial feminization surgeries are procedures aimed to change the features of the male face to that of a female face. These include contouring of the forehead, brow lift, mandible angle reduction, genioplasty, rhinoplasty and a variety of soft tissue adjustments. In our maxillofacial surgery department at the Sheba Medical Center we perform forehead reshaping combining with brow lift and at the same surgery, mandibular and chin reshaping to match the remodeled upper third of the face. The forehead reshaping is done by cranioplasty with additional reduction of the glabella area by burring of the frontal bone. After reducing the frontal bossing around the superior orbital rims we manage the soft tissue to achieve the brow lift. The mandibular reshaping, is performed by intraoral approach and include contouring of the angles by osteotomy for a more round shape (rather than the manly square shape angles), as well as reshaping of the bone in the chin area in order to make it more pointy, by removing the lateral parts of the chin and in some cases performing also genioplasty reduction by AP osteotomy.
易性癖是一种性别认同障碍，患者强烈渴望以异性成员的身份生活并被接纳。对于具有明显男性面部特征的男变女易性癖者，面部女性化手术是性别重置的一部分。女性气质与吸引力之间的紧密联系被认为与面部上三分之一以及前额眉间隆起的相互作用有关。研究表明，特定的下颌形状是男性的特征，尤其要注意明显的方形下颌角和下巴，并且还表明有吸引力的女性下颌较小，下颌角更圆润，下巴较尖。其他研究表明，通过颅骨整形术使前额女性化对确定患者性别具有最显著的影响。面部女性化手术旨在将男性面部特征改变为女性面部特征。这些手术包括前额塑形、提眉、下颌角缩小、颏成形术、鼻整形术以及各种软组织调整。在舍巴医疗中心的颌面外科，我们进行前额重塑并结合提眉手术，同时在同一手术中进行下颌和下巴重塑，以匹配重塑后的面部上三分之一。前额重塑通过颅骨整形术完成，并通过磨削额骨进一步减少眉间区域。在减少眶上缘周围的额部隆起后，我们处理软组织以实现提眉效果。下颌重塑通过口内入路进行，包括通过截骨术使下颌角更圆润（而不是男性化的方形角度）来塑形，以及通过去除下巴外侧部分并在某些情况下通过前后截骨术进行颏成形术缩小来重塑下巴区域的骨骼，使其更尖。
