From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University; Section of Plastic Surgery, University of Michigan; Department of Plastic Surgery, University of Texas Southwestern Medical Center; Dallas Plastic Surgery Institute; Division of Plastic Surgery, Baylor College of Medicine; and Align Surgical Associates.
Plast Reconstr Surg. 2022 Jan 1;149(1):107-115. doi: 10.1097/PRS.0000000000008654.
Iatrogenic jowling can be an unintended consequence of facial feminization surgery. Reduction of the mandible and chin without overlying changes to the soft tissue can lead to a redundant and deflated soft-tissue envelope, requiring a face lift to address jowling, cervicofacial laxity, and/or lower facial rhytids. Prospective quality-of-life outcomes data support this hypothesis, as patients who underwent mandible contouring with or without angle osteotomies were significantly more likely to express interest in face lift following facial feminization surgery on univariable analysis (90.0 percent versus 10.0 percent, p = 0.038). Patients with inherent skin laxity are at particularly high risk, such as those with advancing age, extrinsic skin damage (e.g., sun exposure, cigarette smoke), and history of massive weight loss. Before facial feminization surgery, the authors recommend comprehensive patient counseling that includes a discussion of the possible future need for a face lift, preferably around 1 year after facial feminization surgery. When performing a face lift after facial feminization surgery, technical considerations include those related to sequelae of prior facial surgery, anatomical differences between cismale and cisfemale facial soft tissue, and the mechanism of jowling after facial feminization surgery versus normal facial aging. The authors believe that these considerations can set more realistic expectations for facial feminization surgery patients, improve surgeons' ability to skillfully execute this procedure, and ultimately contribute to ongoing quality-of-life improvements in facial feminization surgery patients.
医源性下颌松垂可能是面部女性化手术的意外后果。如果不对面部软组织进行覆盖性改变而减少下颌骨和下巴，可能会导致多余和瘪陷的软组织包膜，需要进行面部提升术来解决下颌松垂、颈部和面部松弛以及/或下面部皱纹。前瞻性的生活质量结果数据支持这一假设，因为在单变量分析中，接受下颌骨整形术（无论是否行下颌角截骨术）的患者在面部女性化手术后表达对面部提升术兴趣的可能性显著更高（90.0%对 10.0%，p=0.038）。皮肤固有松弛的患者风险特别高，例如年龄增长、外在皮肤损伤（如日晒、香烟烟雾）以及大量体重减轻史的患者。在进行面部女性化手术之前，作者建议进行全面的患者咨询，包括讨论未来可能需要进行面部提升术的问题，最好在面部女性化手术后 1 年左右进行讨论。在进行面部女性化手术后进行面部提升术时，技术方面的考虑因素包括与先前面部手术的后遗症、顺性别男性和女性面部软组织之间的解剖差异以及面部女性化手术后和正常面部衰老导致下颌松垂的机制有关。作者认为，这些考虑因素可以为面部女性化手术患者设定更现实的期望，提高外科医生熟练执行该手术的能力，并最终有助于面部女性化手术患者持续改善生活质量。
