{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T23:33:07Z","timestamp":1772839987982,"version":"3.50.1"},"reference-count":9,"publisher":"Springer Science and Business Media LLC","issue":"23","license":[{"start":{"date-parts":[[2024,9,18]],"date-time":"2024-09-18T00:00:00Z","timestamp":1726617600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,9,18]],"date-time":"2024-09-18T00:00:00Z","timestamp":1726617600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Bernard G. Sarnat Endowment for Craniofacial Biology"},{"DOI":"10.13039\/100000072","name":"National Institute of Dental and Craniofacial Research","doi-asserted-by":"publisher","award":["R01 DE028098"],"award-info":[{"award-number":["R01 DE028098"]}],"id":[{"id":"10.13039\/100000072","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000072","name":"National Institute of Dental and Craniofacial Research","doi-asserted-by":"publisher","award":["R01 DE029234"],"award-info":[{"award-number":["R01 DE029234"]}],"id":[{"id":"10.13039\/100000072","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008918","name":"Jean Perkins Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008918","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["UL1TR001881"],"award-info":[{"award-number":["UL1TR001881"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Aesth Plast Surg"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Feminizing fronto-orbital reconstruction involves one of four possibilities with the Ousterhout Type III anterior table frontal sinus osteotomy and setback performed in most patients while the Type I reduction recontouring is reserved for patients without frontal sinuses or thick anterior tables. However, patients with frontal sinuses and either a moderately thick anterior table or a shallow frontal sinus in the sagittal plane represent an intermediate morphology. For such morphologies, we introduce the novel Type I+ fronto-orbital reconstruction technique, consisting of frontal bone recontouring supplemented with anterior table reconstruction and split cranial bone graft.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>Transgender and gender non-conforming patients who underwent Type I+ or Type III feminizing fronto-orbital reconstruction (2019\u20132023) were included for retrospective review and comparison of techniques.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>In the 123 patients (mean age 32.2\u2009\u00b1\u20099.5 years) included, 6.5% underwent Type I+ and 94.5% underwent Type III feminizing fronto-orbital reconstruction. Morphologically, Type I+ patients displayed a shallower frontal sinus compared to Type III patients (median anterior to posterior table depth 4.1[interquartile range, IQR, 1.1-5.0] versus 9.8[IQR 7.5-12.0]mm, <jats:italic>p<\/jats:italic>&lt;0.001). At the maximum prominence, Type I+ patients also demonstrated thicker anterior tables compared to Type III patients (median 6.6[IQR 5.0-8.8] versus 2.2[IQR 0.4-4.7]mm, <jats:italic>p<\/jats:italic>=0.001). Patients receiving Type I+ procedures underwent an anterior table reduction of 2.7\u00b11.2mm versus 4.2\u2009\u00b1\u20091.2mm for Type III procedures in the sagittal plane (<jats:italic>p<\/jats:italic>=0.002).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>The current work introduces a novel solution to an intermediate frontal sinus phenotype for gender-affirming facial feminization surgery.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Level of Evidence IV<\/jats:title>\n            <jats:p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors  <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/www.springer.com\/00266\" ext-link-type=\"uri\">www.springer.com\/00266<\/jats:ext-link>. <\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00266-024-04341-2","type":"journal-article","created":{"date-parts":[[2024,9,18]],"date-time":"2024-09-18T20:16:14Z","timestamp":1726690574000},"page":"4778-4783","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The Type I+ Forehead in Facial Feminization Surgery"],"prefix":"10.1007","volume":"48","author":[{"given":"Shahrzad","family":"Moghadam","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaavian","family":"Shariati","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelly X.","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Madeline G.","family":"Chin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonnby S.","family":"LaGuardia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meiwand","family":"Bedar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sumun","family":"Khetpal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brendan J.","family":"Cronin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8943-0837","authenticated-orcid":false,"given":"Justine C.","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,9,18]]},"reference":[{"key":"4341_CR1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000010594","author":"MG Chin","year":"2021","unstructured":"Chin MG, LaGuardia JS, Morgan KB, Ngo H, Moghadam S, Huang KX, Bedar M, Cronin BJ, Kwan D, Lee JC (2021) United States Health Policies on Gender-Affirming Care in 2022. Plast Reconstr Surg. https:\/\/doi.org\/10.1097\/PRS.0000000000010594","journal-title":"Plast Reconstr Surg"},{"key":"4341_CR2","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.14338","author":"JS LaGuardia","year":"2024","unstructured":"LaGuardia JS, Chin MG, Fadich S et al (2024) Medicaid coverage for gender\u2010affirming surgery: a state\u2010by\u2010state review. Health Services Research. https:\/\/doi.org\/10.1111\/1475-6773.14338","journal-title":"Health Services Research"},{"key":"4341_CR3","unstructured":"Ousterhout DK (2010) Facial feminization surgery: a guide for the transgendered woman. Addicus Books"},{"key":"4341_CR4","doi-asserted-by":"publisher","first-page":"701","DOI":"10.1097\/00006534-198705000-00003","volume":"79","author":"DK Ousterhout","year":"1987","unstructured":"Ousterhout DK (1987) Feminization of the forehead: Contour changing to improve female aesthetics. 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Gend Affirm Surg, Issue Oral Maxillof Surg Clin N Am 36(2):171","journal-title":"Gend Affirm Surg, Issue Oral Maxillof Surg Clin N Am"}],"container-title":["Aesthetic Plastic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00266-024-04341-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00266-024-04341-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00266-024-04341-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,16]],"date-time":"2025-01-16T16:03:08Z","timestamp":1737043388000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00266-024-04341-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,18]]},"references-count":9,"journal-issue":{"issue":"23","published-print":{"date-parts":[[2024,12]]}},"alternative-id":["4341"],"URL":"https:\/\/doi.org\/10.1007\/s00266-024-04341-2","relation":{},"ISSN":["0364-216X","1432-5241"],"issn-type":[{"value":"0364-216X","type":"print"},{"value":"1432-5241","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,18]]},"assertion":[{"value":"6 March 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 August 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 September 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All authors have no financial interests, including products, devices, or drugs associated with this manuscript. The authors declare that they have no conflicts of interest to disclose aside from the senior author being a medical education consultant for Stryker. All sources of funds supporting the completion of this manuscript are under the auspices of our affiliated academic institution.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Informed consent is not required for this type of study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed Consent"}},{"value":"This article does not contain any studies with human participants or animals performed by any of the authors.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statement of Human and Animal Rights, or Ethical Approval"}}]}}