title: Facial feminization surgery: the forehead. Surgical techniques and analysis of results.
abstract: BACKGROUND
  Facial feminization surgery encompasses a series of surgical techniques derived from plastic and craniomaxillofacial surgery to soften facial features that are generally perceived as being more masculine, mainly in patients diagnosed with gender dysphoria. This article describes the main surgical techniques used in feminization of the forehead complex, sequences the different steps in forehead reconstruction, evaluates results obtained using cephalometric analysis, and includes the level of patient satisfaction.
  
  
  METHODS
  Between January of 2008 and December of 2012, the authors performed a total of 172 forehead operations. The postsurgical results were analyzed using postoperative cephalometric studies that were compared with preoperative teleradiographies. The patients' level of satisfaction was also evaluated using a satisfaction questionnaire that they filled out after a 6-month postoperative period.
  
  
  RESULTS
  Along with an evaluation of patient satisfaction and clinical and cephalometric results where significant setback of the frontal bossing was observed, the authors present the sequencing of frontonasal-orbital reconstruction/recontouring with systematic osteotomy of the anterior wall of the frontal sinus in addition to developing a modification of the standard coronal approach.
  
  
  CONCLUSIONS
  By treating the forehead region with the different surgical procedures described in this article, masculine facial features of the upper third can be modified with predictable and satisfactory results. Facial feminization surgery must be considered part of the process of treating patients with gender dysphoria, because the modification and elimination of masculine facial features allows these patients to adapt more easily to the workplace and social and family environments.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Marbella, Málaga, Spain From the MHC International Hospital, Facial Team Surgical Group.
authors.forename: Luis
authors.initials: L
authors.lastname: Capitán
authors.forename: Daniel
authors.initials: D
authors.lastname: Simon
authors.forename: Kai
authors.initials: K
authors.lastname: Kaye
authors.forename: Thiago
authors.initials: T
authors.lastname: Tenorio
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005262:Feminization; D005546:Forehead / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D019651:Plastic Surgery Procedures / Q000379:methods; D011795:Surveys and Questionnaires; D055815:Young Adult