UCSF Surgeons Standardize Brow Lift and Hairline Surgery Using Photo Analysis

Facial Feminization Surgery (FFS) involves numerous procedures designed to give the face a more feminine and harmonious appearance. Feminizing procedures such as hairline advancement, brow lift, rhinoplasty, genioplasty and chondrolaryngoplasty, also known as “tracheal shave,” provide definition and eliminate sources of continued misgendering for the patient.

The upper facial third is an important area to address in FFS and surgeons at UCSF have quantified the outcomes of trichophytic brow lift and hairline advancement in a study published Dec. 29, 2022 in Facial Plastic Surgery & Aesthetic Medicine.

Feminizing modification to the eyebrows, hairline and forehead in transgender women undergoing gender-affirming facial surgery were measured on photographs and helped advise patients and track surgeon outcomes.

In the study, pre and postoperative frontal view photographs underwent computer-aided photograph analysis. Brow position, hairline position and forehead height were measured.

Patient self-identified, race, ethnicity and other demographic factors were also collected.

Forty-six patients underwent FFS with a brow lift and hairline advancement with photographed permitting measurement. Eyebrow analysis was performed in 33 patients. Hairline and forehead analyses were accomplished in 30 patients. In the study’s patient series, the brow was successfully elevated across all sites and the hairlines and forehead heights were reduced significantly. On average, 4-5 mm of brow lift, 6-7 mm of hairline lowering and 10-11 mm of forehead reduction were achieved, contributing to a more feminine appearance of the upper facial third.

These transformations together created a more feminine appearance to the upper facial third and is considered to play a particularly important role in determining the perception of facial gender.

“These types of surgeries may be life-altering for patients with gender dysphoria," said P. Daniel Knott, MD, FACS, professor and director of facial cosmetic and reconstructive surgery within the UCSF Department of Otolaryngology-Head and Neck Surgery. “The psychological distress arises from incongruence between sex assigned at birth and internal gender identity.”

Reliable objective surgical outcome measures are beneficial for patient counseling and for the surgeon to critically appraise their results. These measures will likely be improved with the advancement and increased accessibility of 3D facial scanning technology.

Authors: Abel P. David, MD; Adrian E. House, MD; Sonia Targ, MS; Andrea M. Park, MD; Rahul Seth, MD; and P. Daniel Knott, MD

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