scholarly journals Evaluation and treatment of facial feminization surgery: part I. forehead, orbits, eyebrows, eyes, and nose

2021 ◽  
Vol 48 (5) ◽  
pp. 503-510
Author(s):  
Brian N. Dang ◽  
Allison C. Hu ◽  
Anthony A. Bertrand ◽  
Candace H. Chan ◽  
Nirbhay S. Jain ◽  
...  

Facial feminization surgery (FFS) incorporates aesthetic and craniofacial surgical principles and techniques to feminize masculine facial features and facilitate gender transitioning. A detailed understanding of the defining male and female facial characteristics is essential for success. In this first part of a two-part series, we discuss key aspects of the general preoperative consultation that should be considered when evaluating the prospective facial feminization patient. Assessment of the forehead, orbits, hairline, eyebrows, eyes, and nose and the associated procedures, including scalp advancement, supraorbital rim reduction, setback of the anterior table of the frontal sinus, rhinoplasty, and soft tissue modifications of the upper and midface are discussed. In the second part of this series, bony manipulation of the midface, mandible, and chin, as well as soft tissue modification of the nasolabial complex and chondrolaryngoplasty are discussed. Finally, a review of the literature on patient-reported outcomes in this population following FFS is provided.

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e035546
Author(s):  
Leopold Hentschel ◽  
Stephan Richter ◽  
Hans-Georg Kopp ◽  
Bernd Kasper ◽  
Annegret Kunitz ◽  
...  

ObjectivesThe choice of drug treatment in advanced soft tissue sarcoma (STS) continues to be a challenge regarding efficacy, quality of life (QoL) and toxicity. Unlike other cancer types, where integrating patient-reported outcomes (PRO) has proven to be beneficial for QoL, there is no such evidence in patients with STS as of now. The YonLife trial aimed to explore the effect of a tailored multistep intervention on QoL, symptoms and survival in patients with advanced STS undergoing treatment with trabectedin as well as identifying predictors of QoL.DesignYonLife is a cluster-randomised, open-label, proof-of-concept study. The intervention incorporates electronic PRO assessment, a case vignette and expert-consented treatment recommendations.ParticipantsSix hospitals were randomised to the control arm (CA) or interventional arm (IA). Seventy-nine patients were included of whom 40 were analysed as per-protocol analysis set.Primary and secondary outcome measuresThe primary end point was the change of Functional Assessment for Cancer Therapy (FACT-G) total score after 9 weeks. Secondary outcomes included QoL (FACT-G subscales), anorexia and cachexia (Functional Assessment of Anorexia/Cachexia Therapy (FAACT)), symptoms (MD Anderson Symptom Inventory (MDASI)), anxiety and depression (HADS), pain intensity and interference (Brief Pain Inventory (BPI)) and survival assessment.ResultsAfter 9 weeks of treatment, QoL declined less in the IA (ΔFACT-G total score: −2.4, 95% CI: −9.2 to 4.5) as compared with CA (ΔFACT-G total score: −3.9; 95% CI:−11.3 to 3.5; p=0.765). In almost all FACT-G subscales, average declines were lower in IA, but without reaching statistical significance. Smaller adverse trends between arms were observed for MDASI, FAACT, HADS and BPI scales. These trends failed to reach statistical significance. Overall mean survival was longer in IA (648 days) than in CA (389 days, p=0.110). QoL was predicted by symptom severity, symptom interference, depression and anxiety.ConclusionOur data suggest a potentially favourable effect of an electronic patient-reported outcomes based intervention on QoL that needs to be reappraised in confirmatory studies.Trial registration numberClinicalTrials.gov Identifier (NCT02204111).


10.29007/vwhp ◽  
2020 ◽  
Author(s):  
Julien Bardou-Jacquet

Achieving a balanced total knee throughout the entire range of motion leads to improved patient reported outcomes and satisfaction. Sensor-assisted technology allows the surgeon to quantitatively assess and address imbalance through either soft tissue releases or bone recuts. However, balancing through soft tissue releases leads to unpredictable gap increments and frequent early over-releases.METHODS: During a consecutive and prospective series of 29 robotic total knee surgeries, intra-operative load sensors were used following the initial bone resections to quantitatively assess the knee’s state of balance through the range of motion with trial components in place. Load measurements were taken at 10 and 90 degrees of knee flexion. Based on previous literature, a balanced knee is defined as having a mediolateral load difference below 15 pounds (lbf) through the range of motion, with an absolute load magnitude per compartment above 5lbf and not exceeding 45lbf. The initial load numbers were recorded as well as the number and type of subsequent corrections needed to achieve quantitative balance.RESULTS Of the 29 robotics cases, only 12 (41%) were well-balanced after the initial bone cuts (mechanical alignment by measured resection). Another two cases were too loose and required an increase in the polyethylene thickness size of two millimeters to achieve a well-balanced knee without further bone resection. In 14 cases, a bone recut was required to balance the knee. More specifically, four cases required a recut of the femur, ten cases required a recut of the tibia. Eventually, one case was left unbalanced in flexion with a mediolateral load differential of 20 lbf. It should be noted explicitly that no soft tissue releases were done for any of the 29 cases. At the end, all 29 knees were considered well balanced in extension and all but six (79%) at 90° of flexion. For these six cases with balance issue at 90° of flexion, absolute load magnitude in both compartments was below 45 lbf and above 5lbf, though the mediolateral load differential was between 15lbf and 30lbf.DISCUSSION Based on a preliminary series, this work demonstrates the opportunity of combining multiple technologies to achieve a quantitatively balanced knee through the range of motion without any soft tissue release.


2018 ◽  
Vol Volume 12 ◽  
pp. 733-747 ◽  
Author(s):  
Juan Torre-Alonso ◽  
Rubén Queiro ◽  
Marta Comellas ◽  
Luís Lizán ◽  
Carles Blanch

2019 ◽  
Vol 46 (2) ◽  
pp. 148-154 ◽  
Author(s):  
Kate Parker ◽  
Farhad B Naini ◽  
Daljit S Gill ◽  
Keith Altman

Facial feminisation surgery (FFS) aims to feminise the face by changing masculine facial features to feminine ones. It is commonly undertaken for transsexual individuals who are transitioning from male to female or for women who wish to further feminise their facial appearance. Assessment and treatment planning by a multidisciplinary team is essential for any patient considering FFS. Orthodontists have an important role within this team as patients may first present to an orthodontist expressing concerns about the appearance of their jaws. Therefore, it is important that orthodontists have a detailed understanding of FFS procedures, to enable good patient communication, thorough patient assessment and onwards referral where required. This article reviews the common FFS procedures, their indications, and the benefits and risks of each procedure and highlights the role of the orthodontist.


2021 ◽  
pp. 000313482110385
Author(s):  
Adrienne N. Christopher ◽  
Martin P. Morris ◽  
Louis-Xavier Barrette ◽  
Viren Patel ◽  
Robyn B. Broach ◽  
...  

Purpose Posterior component separation with transversus abdominis release (TAR) enables medial myofascial flap advancement in complex abdominal wall reconstruction. Here, we add to a growing body of literature on TAR by assessing longitudinal clinical and patient-reported outcomes (PROs) after complex ventral hernia repair (VHR) with TAR. Methods Adult patients undergoing VHR with TAR between 10/15/2015 and 1/15/2020 were retrospectively identified. Patients with parastomal hernias and <12 months of follow-up were excluded. Clinical outcomes and PROs were assessed. Results Fifty-six patients were included with a median age and body mass index of 60 and 30.8 kg/m2, respectively. The average hernia defect was 384 cm2 [IQR 205-471], and all patients had retromuscular mesh placed. The most common complications were delayed healing (19.6%) and seroma (14.3%). There were no cases of mesh infection or explantation. Previous hernia repair and concurrent panniculectomy were risk factors for developing complications ( P < .05). One patient (1.8%) recurred at a median follow-up of 25.2 months [IQR 18.2-42.4]. Significant improvement in disease-specific PROs was maintained throughout the follow-up period (before to after P < .05). Conclusion Transversus abdominis release is a safe and efficacious technique to achieve fascial closure and retromuscular mesh in the repair of complex hernia defects.


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