Virtual Surgical Planning for Facial Feminization Surgery: Correlation between 3-Dimensional Plans and Results Varies across Procedures.

[BACKGROUND] Facial feminization surgery encompasses a group of procedures, including frontal sinus setback, genioplasty, and gonial angle reduction, that are used to increase concordance between gender identity and physical appearance. Virtual surgical planning is often used preoperatively by the surgeon to create operative plans customized to the patient's unique anatomy. However, the accuracy of the virtual surgical plans has been poorly documented in the literature.

[METHODS] Virtual surgical plans for frontal sinus setback, suprabrow contouring, genioplasty, and gonial angle reduction were compared with postoperative computed tomography 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 among forehead, chin, and gonial angle procedures using analysis of variance 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 with 89.6% ( P < 0.0001) and 73.0% ( P < 0.0001) for genioplasty and gonial angle reduction, respectively.

[CONCLUSIONS] The current study represents the largest and most comprehensive evaluation of facial feminization surgery virtual surgical planning accuracy in living 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.