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Facial Plastic and Reconstructive Surgery

Radiographic Analysis of Outcomes in Feminizing Cranioplasty

Monday, October 2, 2023
9:15 AM - 9:21 AM East Coast USA Time
Location: 205ABC

    Presenting Author(s)

  • Rui Han Liu, MD

    Resident
    Massachusetts Eye and Ear Infirmary/Harvard Medical School
    Boston, MA, United States

    • Co-Author(s)

  • Minjee Kim

    Medical Student
    Harvard Medical School
    Boston, MA, United States

    • Senior Author(s)

  • David A. Shaye, MD

    Assistant Professor
    Harvard Medical School
    Boston, MA, United States

Disclosure(s):
Rui Han Liu, MD: No relevant relationships to disclose.
David A. Shaye, MD: No relevant relationships to disclose.
Introduction: The upper third of the face has been shown to have the strongest association with femininity and attractiveness. Feminizing cranioplasty surgically reduced frontal bossing and is increasingly popular in the transgender population. Existing literature have reported on safety and patient-reported outcomes but to date, there has not been a radiographic study that analyzed objective changes in bony contour of the forehead.

Methods: A retrospective study was performed at a single institution (Massachusetts Eye and Ear) for male-to-female transgender patients who underwent feminizing cranioplasty between December 2019 and October 2022. The primary outcomes were radiographic measurements obtained from preoperative and postoperative CT scans, including the nasofrontal angle and angle of deviation from the ideal female forehead slope.

Results: Twenty-eight patients with a mean age of 42 (range 22-65) were included. Average follow-up was 7 months. The complication rate was 7.1% (n = 2). All patients had a pneumatized frontal sinus with preoperative anterior table thickness of 2.9mm (+/-1.1mm). The nasofrontal angle increased from 108.6 degrees (+/-16.0) to 133.2 degrees (+/-10.0) (p = 0.006) and the angle of deviation from the ideal female forehead decreased from 34.6 degrees (+/-10.0) to 17.6 degrees (+/-10.5) (p = 0.006). The anteroposterior dimension of the frontal sinus at the mid-sagittal plane decreased from 18.9mm (+/-3.0mm) to 15.0mm (+/-3.2mm) (p = 0.025).

Conclusions: Feminizing cranioplasty in the transgender population leads to measurable and significant changes in the nasofrontal angle and assimilates the bony contour to the ideal female forehead. Further study is underway to correlate the radiographic outcomes with physician and patient-reported outcomes.