July 11, 2019 Nearly a half century ago, a colleague walked into the office of Dr. Mutaz B. Habal, leading craniofacial surgeon, and asked an unexpected question: Could he help improve the results of facial feminization surgery in a transgender woman? The ensuing journey has led to continual advances and refinements in techniques of facial gender confirmation surgery for transgender patients, as presented in the special July/August issue of The Journal of Craniofacial Surgery, published by Wolters Kluwer.
Dr. Habal is joined by other pioneering surgeons and the next generation of experts to provide insights on the history, current techniques, and future of transgender facial surgery. "Based on the background of sound craniofacial principles and techniques, the journal felt it appropriate to initiate a special edition sharing recent developments and future directions for transgender surgery," according to a special editorial by Seth R. Thaller, MD, DMD. Dr. Thaller is one of the of the guest editors of the special issue, along with Mimis Cohen, MD, and Dr. Habal, who is JCS Editor-in-Chief.
Milestones and ongoing development of transgender facial surgery
The special issue papers share perspectives on how the art and science of facial feminization surgery have developed over the years. Building on the work of previous surgeons, Dr. Habal authored a key paper on feminization of the facial skeleton, addressing critical areas from the forehead, to the midface (cheeks and nose), to the chin and jaw.
Douglas K. Ousterhout, MD, DDS, contributed further advances in understanding the differences between the male and female skulls and in adapting craniofacial surgery techniques largely developed to manage congenital deformities in children to transgender facial surgery. In a special editorial, Dr. Ousterhout states his belief that upper facial feminization surgery is best performed by surgeons with specialty craniofacial training.
Jeffrey H. Spiegel, MD, discusses insights and techniques from 20 years of experience in working with thousands of women seeking facial feminization. He concludes "Facial feminization is a rewarding array of surgical techniques that permit the surgeon to operate at the leading edge of advancement in the field."
Today, facial gender confirmation (or affirmation) surgery is a well-accepted treatment for gender dysphoria: "the distress that originates from the incongruence of gender identify and birth phenotype," according to an article by Nick Esmonde, MD, MPH, and colleagues. More than just altering the person's facial appearance, gender confirmation surgery reduces the high risk of depression, suicidality, anxiety, drug abuse, and social isolation associated with gender dysphoria. Treatment involves understanding the transgender experience and the social transition, involvement of a mental health professional, and providing affirming care in every aspect of the experience.
Eva A. Williams, MS, and colleagues provide a public health perspective on gender affirmation surgery, including issues related to healthcare access, education for surgeons performing these complex procedures, and mental health outcomes. Other aspects of current practice addressed in the special issue include:
- Thyroid chondroplasty and laryngoplasty â€“ Reducing the "Adam's apple" while protecting the voice.
- Facial masculinization surgery â€“ although less common than feminization surgery, facial masculinization is expected to become more widely accepted and available.
- The role of imaging studies for planning and documentation of facial gender affirmation surgery.
Loren S. Schechter, MD, and Dr. Cohen look at the future of gender confirmation surgery in transgender patients, touching on issues of transgender rights, insurance coverage and access to care. They conclude, "Facial surgery can help alleviate gender dysphoria, and surgeons play an important role in providing care and contributing to the multidisciplinary healthcare team."
About The Journal of Craniofacial Surgery
The Journal of Craniofacial Surgery serves as a forum of communication for all those involved in craniofacial and maxillofacial surgery. Coverage ranges from practical aspects of craniofacial surgery to the basic science that underlies surgical practice. Affiliates include 14 major specialty societies around the world, including the American Association of Pediatric Plastic Surgeons, the American Academy of Pediatrics Section of Pediatric Plastic Surgery, the American Society of Craniofacial Surgeons, the American Society of Maxillofacial Surgeons, the Argentine Society of Plastic Surgery Section of Pediatric Plastic Surgery, the Asian Pacific Craniofacial Association, the Association of Military Plastic Surgeons of the U.S., the Brazilian Society of Craniofacial Surgeons, the European Society of Craniofacial Surgery, the International Society of Craniofacial Surgery, the Japanese Society of Craniofacial Surgery, the Korean Society of Craniofacial Surgery, the Thai Cleft and Craniofacial Association, and the World Craniofacial Foundation.