Louis Matthew, Travieso Roberto, Oles Norah, Coon Devin
Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Johns Hopkins Center for Transgender Health, Johns Hopkins Hospital, Baltimore, MD, USA.
Ann Transl Med. 2021 Apr;9(7):606. doi: 10.21037/atm-20-6432.
Facial gender confirmation surgery (FGCS) is a series of procedures which seek to harmonize a patient's face with his/her self-image and gender identity. Originally described in San Francisco in the 1980s, FGCS has evolved to encompass all elements of the craniofacial skeleton and facial soft tissue. This field in plastic and reconstructive surgery has quickly gained more attention in the past decade due to the pioneering work of groups around the world along with increased social acceptance and medical care of the transgender community. This narrative review focuses on the upper third of the face. Key differences in the forehead and the hairline of cis men and women are discussed which inform pharmacologic and surgical interventions. Hairline modifying therapies including pharmacotherapy and hair transplantation are explained. Virtual surgical planning (VSP), a tool broadly used in surgical fields, has a special role in FGCS and we offer advice in using VSP when addressing the frontal sinus. Use of VSP allows the surgeon to provide reproducible and accurate results. We then discuss the history of the frontal sinus setback and offer our algorithmic approach to recontouring the forehead with detailed description of the operative steps and decision making. Finally, postoperative care and complications considered.
面部性别确认手术（FGCS）是一系列旨在使患者面部与自我形象及性别认同相协调的手术。FGCS最初于20世纪80年代在旧金山被描述，现已发展到涵盖颅面骨骼和面部软组织的所有要素。由于世界各地团队的开创性工作以及跨性别群体社会认可度和医疗护理的提高，整形与重建外科的这一领域在过去十年中迅速受到更多关注。本叙述性综述聚焦于面部上三分之一部分。讨论了顺性别男性和女性在前额和发际线方面的关键差异，这些差异为药物和手术干预提供了依据。解释了包括药物治疗和毛发移植在内的发际线调整疗法。虚拟手术规划（VSP）是外科领域广泛使用的一种工具，在FGCS中具有特殊作用，我们在处理额窦时提供使用VSP的建议。使用VSP可使外科医生提供可重复且准确的结果。然后我们讨论额窦后缩的历史，并提供我们重新塑造前额轮廓的算法方法，详细描述手术步骤和决策过程。最后，考虑术后护理及并发症。
