Enhancing Outcomes By Optimizing The Nasofrontal Angle: Surgical Decision Making In Gender Affirmation Surgery
Angela Rodriguez, MD1, Mark Constantian, MD2.
1Align Surgical Associates, San Francisco, CA, USA, 2International Center for Rhinoplasty, Nashua, NH, USA.
Enhancing outcomes by optimizing The Nasofrontal Angle: surgical decision making in Gender Affirmation Surgery PURPOSE: Precise preoperative planning around the nasofrontal area correlate with better aesthetic outcomes. Forehead remodeling and frontal sinus setback can be performed with or without rhinoplasty in the setting of facial feminization surgery. The authors review their experience with these procedures and illustrate the importance of the nasofrontal angle in the overall outcome of the feminized face. METHOD: The authors present their surgical experience with 37 cases involving forehead remodeling and frontal sinus setback with and without rhinoplasty. Careful analysis of photographic registry and cephalometric measurements were obtained. RESULTS: Pre and post-operative photographs of patients were reviewed. Nasofrontal angle measurements were performed on all available lateral view photographs. Nasofrontal angle increased an average of 9 degrees in the postoperative patients, (ranging from -1 to 18 degrees) with the vast majority of the patients obtaining a more obtuse angle in the postoperative photographs (P< 0.05). Photographic records also showed a subjectively more "feminine" profile when photographs were judged by other clinicians. When rhinoplasty was not performed, results were mixed. CONCLUSION: Careful preoperative planning and decision making on how to enhance an important feature like the nasofrontal angle is of paramount importance in upper face feminization. Although the perception of "feminine" is subjective, our findings demonstrate that even a mild change in the nasofrontal area correlates with improved outcomes on our patient population.
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