Istranov A.L., Lyubchenko A .V., Isakova Yu.I., Mkhitaryan O.A., Arutyunyan E.G. Feminization of the middle third of the face. Head and neck. Russian magazine = Head and neck. Russian Journal. 2022;10(2):78–84

Objective. To highlight the current situation on the topic of feminizing surgery of the middle third of the face as one of the main stages of the general feminization of male-to-female transsexuals’ appearance, as well as to emphasize the significance of this issue for the present day.
Material and methods. 5 0 ar tic les were reviewed, material from 29 ar tic les was inc luded in the review. The literature search was carried out using the Scopus, Web of Science, PubMed, Google Scholar, Cochrane library, Elsevier databases. The main criterion for inclusion was the relevance of the conducted methods and studies,specific for transexual patients.
Results. Previously, in transexual patients, operations in the urogenital area were considered the main ones, however, according to the experience of recent years, there is a tendency that patients prefer surgical correction of visible body parts that determine the sex of a person. The face is one of the most visible external signs that determine gender, and misinterpretation by others of the appearance of transsexuals can not only affect the mental health of these patients, but also exacerbate discrimination resulting from transphobia. Operations aimed at feminization of the face in transexual patients are relevant and medically necessary elements in the treatment of gender dysphoria. This work summarized modern concepts and standards of feminizing surgery of the middle third of the face. The following sections are presented in detail, such as surgery planning, ideal proportions of the face; anatomical features and structure of the middle third of the face in men and women; techniques of feminizing surgery of the middle third of the face and their possible complications; recommendations for the postoperative period management of patients; patient satisfaction with the results of operations. The middle third of the face is the central area of the face that determines the overall appearance. Feminizing surgery of the middle third of the face includes a number of procedures in the area of the zygomatic complex, the area of the nose, nasolabial folds, the upper lip. Midface feminization surgery includes a group of surgical procedures designed to soften and modify facial features that are perceived as masculine or inharmonious. Knowledge of the structural features of female and male faces allows a detailed approach to the issue of feminization, to achieve a more natural result.
Conclusion. The concept of sex reassignment surgery is to approximate the correspondence between a person’s gender identity and his biological sex. Facial feminizing surgery is the most important component of sex-transforming
surgery, and has recently become increasingly important in the life of patients with gender identity disorders, which allows such patients to accept a new identity better, and also improves their social and professional integration.
Key words: gender dysphoria, facial feminization (FFS), feminizing rhinoplasty, reshaping of the zygomatic complex, rhinoplasty, facial anthropometry
Conflict of interest. The authors declare that there is no conflict of interest.
Funding. There was no funding for this study.

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