Facial feminization: from anatomy to clinical outcomes in gender-affirming surgery
DOI:
https://doi.org/10.24054/cbs.v4i3.4527Keywords:
Gender-Affirming Surgery, Transgender Persons, Facial Bones, Quality of Life, Plastic Surgery ProceduresAbstract
Facial feminization is a vital component of gender-affirming care because the face plays a decisive role in the social perception of gender and in the congruence between appearance and identity. This narrative review aimed to synthesize the anatomical foundations, preoperative assessment criteria, the main surgical and nonsurgical techniques, as well as clinical outcomes, complications, and ethical considerations related to facial feminization. Recent literature was integrated into four major areas: facial sexual dimorphism, individualized assessment, therapeutic approaches, and clinical outcomes. From an anatomical standpoint, the most relevant regions include the forehead, orbital rims, nose, cheeks, mandible, chin, and soft tissues, as these structures largely determine the perception of femininity or masculinization. Preoperative evaluation should be individualized and include clinical history, aesthetic goals, standardized photographic analysis, anthropometric measurements, and high-resolution craniofacial computed tomography to optimize planning and operative safety. Commonly described techniques include hairline advancement, forehead remodeling, supraorbital reduction, rhinoplasty, lip lift, malar augmentation, mandibular reduction, reduction genioplasty, and chondrolaryngoplasty; complementary procedures such as botulinum toxin, fillers, laser therapy, and electrolysis may also be useful in selected cases. The reviewed evidence shows significant improvement in satisfaction, quality of life, gender congruence, and social functioning after surgery, with low overall complications and reintervention. Nevertheless, these procedures require comprehensive informed consent, realistic expectations, and a multidisciplinary approach. In conclusion, facial feminization should be understood not only as an aesthetic resource, but also as an intervention with functional, psychological, and social impact within the comprehensive care of transgender persons.
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