Virtual Surgical Planning for Facial Feminization Surgery: Correlation Between Three-Dimensional Plans and Results Varies Across Procedures
Albert L. Rancu, Paula Flores Perez, Kevin G. Hu, Omar Allam, Katelyn Lewis, Thayer Mukherjee, Michael AlperovichBackground:
Facial feminization surgery (FFS) defines a group of procedures including frontal sinus setback, genioplasty, and gonial angle reduction that are utilized to increase concordance between gender identity and physical appearance. Virtual surgical planning (VSP) is often used preoperatively by the surgeon to create operative plans customized to the patient’s unique anatomy. However, the accuracy of these VSPs has been poorly documented in the literature.
Methods:
Virtual surgical plans for frontal sinus setback, suprabrow contouring, genioplasty, and gonial angle reduction were compared to postoperative computed tomography (CT) imaging. Craniofacial landmarks were used to isolate regions of interest to identify differences in volume, surface area, and other procedure-specific measurements. Conformity of the plan to the postoperative result was calculated and compared between forehead, chin, and gonial angle procedures using ANOVA and post-hoc pairwise t-test analysis.
Results:
A total of 80 patients were analyzed in this study. Forehead volume conformity (92.9%) was significantly higher than that of genioplasty (81.8%) and gonial angle reduction (57.3%) (p<0.0001 for both). The same trend was true for surface area conformity, with a score of 95.8% calculated for forehead procedures compared to 89.6% (p<0.0001) and 73.0% (p<0.0001) for genioplasty and gonial angle reduction respectively.
Conclusion:
The present study, to our knowledge, represents the largest and most comprehensive evaluation of FFS VSP accuracy in live patients to date. Forehead procedures demonstrated the highest degree of conformity to the plan followed by genioplasty and gonial angle reduction. Deviations from the plan represent opportunities for improvement in gender-affirming surgery.