Transgender patients do not identify with their biological gender assigned at birth. Both the genital sex and the secondary sex characteristics that develop during puberty lead to clinically significant psychological distress, also known as gender dysphoria. A complex and extended transition period is usually required that involves numerous diagnostic processes, medical-surgical treatments, and extensive psychological care. All of this is aimed at allowing patients to achieve the physical expression of the gender with which they identify, averting severe psychological conflicts; improving self-esteem and quality of life; and fostering the patient’s successful integration into the workplace, family, and society.1
One of these medical-surgical treatments, facial surgery (popularly known as facial feminization surgery), has steadily gained importance and is emerging as a key element in the complex transition process, primarily for male-to-female transgender patients.2 Despite the evidence regarding the importance of and need for facial treatment for this group, many gaps remain that must be addressed, and views differ about the role that this surgery plays in the treatment algorithm. There is a need for a clear, concise definition of the different treatments involved, the type of patient for whom this surgery is indicated, and its place in the transition process timeline.
One constructive step in this definition process would be to determine the most appropriate nomenclature, one that would establish precise limits regarding the surgical field, when this surgery is indicated, and what its procedures are. In this context, the term “facial gender confirmation surgery,” as proposed in the recent article by Berli et al.,3 provides a more suitable description of this surgery than “facial feminization surgery.” This new term indicates that although the surgical techniques are the same, their objective is very distinct and, moreover, they are intended for specific patients with well-defined needs.
At this time, there is some controversy and confusion regarding the line separating purely aesthetic procedures from procedures required to modify the facial features that are responsible for gender identification.4 Although in some rare cases, the ultimate aim of the procedure is disputable, it is possible to categorically describe the procedures in which the ultimate objective is the modification of the features responsible for facial gender. Basically, facial gender confirmation surgery focuses on those determined by the subject’s craniofacial structure: the frontonaso-orbital complex, the mentomandibular complex, and the thyroid cartilage (Adam’s apple). With more readily available access to care, it is to be expected that patients who identify as trans males will also increasingly seek out some aspects of facial gender confirmation surgery as outlined above.5 In short, a more precise and inclusive nomenclature with a better definition of the core surgical procedures included in facial gender confirmation surgery will help to better consolidate and clarify this developing discipline for patients, professionals, and society in general.
The authors have no financial interest to declare in relation to the content of this article.
The authors thank their team, their families, and their patients.
Luis Capitán, M.D., Ph.D.Daniel Simon, D.M.D.FACIALTEAM Surgical GroupHC Marbella International HospitalMarbella, Málaga, Spain
Jens U. Berli, M.D.Division of Plastic and Reconstructive SurgeryDepartment of SurgeryOregon Health & Sciences UniversityPortland, Ore.
Carlos Bailón, M.D.Raúl J. Bellinga, M.D.Javier G. Santamaría, M.D.Thiago Tenório, M.D.Anabel Sánchez-García, Ph.D.Fermín Capitán-Cañadas, Ph.D.FACIALTEAM Surgical GroupHC Marbella International HospitalMarbella, Málaga, Spain
1. Wylie K, Knudson G, Khan SI, Bonierbale M, Watanyusakul S, Baral S. Serving transgender people: Clinical care considerations and service delivery models in transgender health. Lancet 2016;388:401411.
2. Capitán L, Simon D. Salgado C, Monstrey S, Djordjevic M. Facial feminization surgery: A global approach. In: Gender Affirmation: Medical and Surgical Perspectives. 2016:New York: Thieme Medical; 330.
3. Berli J, Capitán L, Simon D, Bluebond-Langner R, Plemons E, Morrison SD. Facial gender confirmation surgery: Review of the literature and recommendations for Version 8 of the WPATH Standards of Care. Int J Transgenderism 2017;18:264270.
5. Deschamps-Braly JC, Sacher CL, Fick J, Ousterhout DK. 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. 2017;139:883e887e.