Patient with failed facial feminization surgery elsewhere
The patient is a young man from England. He had always felt that he was a woman trapped in a man’s body. It took him a while, but he finally decided to go ahead with his decision of becoming a woman. His parents were very supportive of his decision. He had undergone reduction genioplasty surgery. The results left him disappointed.
Internet search leads the patient to our hospital
It was then that they decided to research the Internet. Together, they searched for a good surgeon for facial feminization surgery. The patient had typical male frontal bossing and a prominent chin. He also desired for hairline reduction. Their search led them to our hospital.
Treatment planning explained to the patient
Dr SM Balaji examined the patient and obtained detailed biometric studies. After detailed analyses of these studies, he explained his treatment plan. He explained that the previous surgery was inadequate and had to be redone. The patient was in complete agreement with his treatment plan.
Patient undergoes facial feminization surgery
Under general anesthesia, markings with scalloped borders were first drawn for hairline reduction. The scalloped borders would enable perfect alignment of the skin margins. Attention was next turned to the frontal bossing. This was after incising the superior margin of the markings. A forehead flap was first retracted to expose the frontal bone. The frontalis muscle was then sectioned and retracted. Prominences over the frontal bone were then reduced to an adequate level. This resulted in a sloping feminine forehead. The skin was then reapproximated over the new frontal bone. Incision was then made over the inferior marking and the excess skin excised. This resulted in perfect approximation of the flap over the frontal bone. The muscle and skin flap was then sutured close. This resulted in complete feminization of the patient’s forehead.
Successful facial feminization surgery performed
Attention was then turned to the reduction genioplasty. A vestibular incision was first made in the anterior mandibular buccal sulcus. Dissection of the tissues exposed the genial tubercle. The patient’s genial tubercle had a typical prominent masculine structure. The plates from his previous surgery were first unscrewed and removed. Osteotomy was then performed with an oscillating saw. The chin was then fixed again with plates after adequate removal of bone. Four holed Y shaped plates were then used to aid to stabilize the osteotomy site. The fixation was very stable. This resulted in good genial reduction.
Incisions were then made in the posterior region of the mandible. Plates from the previous surgery here were then removed. Bone obtained from the reduction genioplasty was then screwed in place here to obtain a good gonial angle. All incisions were then closed with sutures. The patient recovered well from general anesthesia.
