Facial masculinization surgery

Facial masculinization surgery (FMS) is a set of plastic surgery procedures that can transform the patient’s face to exhibit typical masculine morphology. Cisgender men may elect to undergo these procedures, and in the context of transgender people, FMS is a type of facial gender confirmation surgery (FGCS), which also includes facial feminization surgery (FFS) for transgender women.[1]

FMS can include various bony procedures such as chin augmentation, cheek augmentation, as well as augmentation of the forehead, jaw, and Adam's apple. In FMS, most procedures involve "having structures added to give more angles to the face."[2]

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History

Trans men have requested FMS procedures since the 20th century.[3] FMS is currently less common than FFS.[4] Urologist Miriam Hadj-Moussa notes that "transgender men rarely undergo facial masculinization surgery since testosterone therapy leads to growth of facial hair and makes it easier for them to present."[5]

In 2011, Douglas Ousterhout outlined the available FMS procedures, drawing on the work of Paul Tessier.[6] In 2015 Shane Morrison published an overview of all gender confirming surgeries for trans men, including FMS.[7] In 2017, Ousterhout's successor Jordan Deschamps-Braly published a case report on the first female-to-male facial confirmation surgery that included masculinization of the Adam's apple.[8]

According to the World Professional Association for Transgender Health, for many transgender men, FMS is considered medically necessary to treat gender dysphoria.[9][10]

Following the WPATH recommendations, several literature reviews and summaries of the state of the art were published.[11][12][13][14]

Surgical procedures

The surgical procedures most frequently performed during FMS often include facial implants and include the following, as outlined in a special 2018 issue of Clinics in Plastic Surgery edited by Loren Schechter and Bauback Safa.[15]

Forehead augmentation

Forehead augmentation can be done with a customized implant, or with injected materials that are molded into shape before they harden.[16]

Jaw augmentation

Orthognathic surgery was first performed for functional reasons in the late 19th century, with cosmetic procedures being improved and refined throughout the 20th century.[17] It is performed with fillers or customized implants.

Chin augmentation

Chin augmentation, also called a mentoplasty or genioplasty, is performed with fillers or customized implants. It can also be performed with an osteotomy plus an implant made of alloplastic materials like Proplast I, Proplast II, and porous block hydroxyapatite.[18]

Adam’s apple augmentation

This newer procedure uses an implant made from cartilage taken from the patient’s rib cage.[8]

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See also

References
  1. Deschamps-Braly JC (2018). Facial Gender Confirmation Surgery: Facial Feminization Surgery and Facial Masculinization Surgery. Clinics in Plastic Surgery, July 2018 Volume 45, Issue 3, Pages 323–331. doi:10.1016/j.cps.2018.03.005
  2. Yarbrough E (2018). Transgender Mental Health. American Psychiatric Association Publishing. ISBN 9781615371136
  3. Ng EM (1999). Sexuality in the New Millennium: Proceedings of the 14th World Congress of Sexology, Hong Kong SAR, China, August 23-27, 1999. Compositori ISBN 9788877942296
  4. Colebunders B, D’Arpa S, Weijers S, Lumen N, Hoebeke P, Monstrey S (2016). Female-to-Male Gender Reassignment Surgery. In Ettner R, Monstrey S, Coleman E, Eds. Principles of Transgender Medicine and Surgery. Routledge ISBN 9781317514602
  5. Hadj-Moussa M, Agarwal S, Ohl DA, Kuzon WM (2018). Masculinizing Genital Gender Confirmation Surgery. Sexual Medicine Reviews. doi:10.1016/j.sxmr.2018.06.004
  6. Ousterhout DK (2011). Dr. Paul Tessier and facial skeletal masculinization. Ann. Plast. Surg. 67, S10–S15. doi:10.1097/SAP.0b013e31821835cb
  7. Morrison SD, Perez MG, Nedelman M, Crane CN (2015). Current State of Female-to-Male Gender Confirming Surgery. Current Sexual Health Reports 7(1) January 2015 doi:10.1007/s11930-014-0038-2
  8. Deschamps-Braly JC, Sacher CL, Fick J, Ousterhout DK (2017). First female-to-male facial confirmation surgery with description of a new procedure for masculinization of the thyroid cartilage (Adam's apple). Plast. Reconstr. Surg. 139, 883e–887e.
  9. World Professional Association for Transgender Health (2016). Position Statement on Medical Necessity of Treatment, Sex Reassignment, and Insurance Coverage in the U.S.A. Page accessed September 8, 2018
  10. World Professional Association for Transgender Health. Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People, Version 7. Archived 2015-08-14 at the Wayback Machine pg. 58 (2012).
  11. Berli JU, Capitán L, Simon D, Bluebond-Langner R, Plemons E, Morrison SD (2017). Facial gender confirmation surgery—review of the literature and recommendations for Version 8 of the WPATH Standards of Care. International Journal of Transgenderism Volume 18, 2017 - Issue 3 doi:10.1080/15532739.2017.1302862
  12. Capitán L, Simon DD, Berli JU, Bailón C, Bellinga RJ, Santamaría JG, Tenório T, Sánchez-García A, Capitán-Cañadas F (2017). Facial Gender Confirmation Surgery: A New Nomenclature. Plastic and Reconstructive Surgery November 2017 - Volume 140 - Issue 5 - p 766e–767e doi:10.1097/PRS.0000000000003798
  13. Morrison SD, Chen ML, Crane CN (2017). An overview of female-to-male gender-confirming surgery. Nature Reviews Urology 14, pp. 486–500. doi:10.1038/nrurol.2017.64
  14. Massenburg BB, Morrison SD, Rashidi V, Miller C, Grant DW, Crowe CS, Velasquez N, Shinn JR, Kuperstock JE, Galaiya DJ, Chaiet SR, Bhrany AD (2018). Transgender Educational Study Group. Educational Exposure to Transgender Patient Care in Otolaryngology Training. J Craniofac Surg 2018 Jul;29(5):1252-1257. doi:10.1097/SCS.0000000000004609
  15. Schechter LS, Safa B, Eds. (2018). Gender Confirmation Surgery. Clinics in Plastic Surgery. Volume 45, Issue 3, Pages 295-446 (July 2018). ISBN 9780323610742
  16. Park DK, Song I, Lee JH, You YJ (2013). Forehead Augmentation with a Methyl Methacrylate Onlay Implant Using an Injection-Molding Technique. Arch Plast Surg. 2013 Sep; 40(5): 597–602.doi:10.5999/aps.2013.40.5.597
  17. Puricelli E (2007). A new technique for mandibular osteotomy. Head Face Med. 2007; 3: 15. doi:10.1186/1746-160X-3-15
  18. Moenning JE, Wolford LM (1989). Chin augmentation with various alloplastic materials: a comparative study. Int J Adult Orthodon Orthognath Surg. 1989;4(3):175-87. PMID 2561746
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