In this episode, Dr. Gopi Shah discusses facial masculinization surgery with facial plastic surgeons Dr. P. Daniel Knott of UCSF and Dr. Rahul Seth of Golden State Plastic Surgery.

First, the surgeons begin by defining gender terminology, facial analysis, and surgical planning as they relate to gender-affirming care. Narrowing in on facial masculinization, they address common surgical procedures including augmentation rhinoplasty, buccal fat removal, reverse brow lifts, chin implants, and thyroid cartilage augmentation. Then, Dr. Knott and Dr. Seth describe the challenge of maintaining a natural appearance while enlarging facial features. In many cases, non-operative adjuncts, such as fillers and Botox, assist in this goal. Finally, Dr. Knott emphasizes the importance of management of the hair in gender-affirming care.

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SHOW NOTES

00:00 - Introduction
05:43 - Importance of Gender Terminology
13:00 - Facial Analysis in Gender Affirming Care
21:45 - Approach to Facial Masculinization
24:11 - Impact of Hormone Therapy
32:56 - Role of Technology in Gender Affirming Care
35:22 - Using Fillers and Botox in Facial Plastic Surgery
36:28 - The Importance of Intentionality in Achieving Patient Goals
37:39 - Exploring Surgical Options for Facial Modification
39:15 - Understanding the Process of Brow Projection Surgery
45:10 - The Process and Challenges of Rhinoplasty
51:31 - The Process and Challenges of Mandible Augmentation
59:20 - The Process and Challenges of Thyroid Cartilage Augmentation

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RESOURCES

Dr. Rahul Seth’s Golden State Plastic Surgery profile:
https://www.goldenstatedermatology.com/staff/rahul-seth-md-facs/

Dr. Daniel Knott’s UCSF profile:
https://www.ucsfhealth.org/providers/dr-p-daniel-knott

Operative Techniques in Otolaryngology chapter covering facial masculinization surgery:
https://www.optecoto.com/article/S1043-1810(23)00011-8/fulltext

Article on three-dimensional morphology to assess gender differences in facial appearance: https://pubmed.ncbi.nlm.nih.gov/35357226/

ENTtoday: “Transgender Care: Otolaryngologists Can Help Fill an Unmet Need for this Patient Population,” Daniel Knott, MD, and Rahul Seth, MD: https://www.enttoday.org/article/transgender-care-otolaryngologists-can-help-fill-an-unmet-need-for-this-patient-population/

ENTtoday: “Gender Affirmation Surgery in California,” Suresh Mohan, MD, Rahul Seth, MD, and Daniel Knott, MD:
https://www.enttoday.org/article/gender-affirmation-surgery-in-california/

Otolaryngologic Clinics of America August 2022 issue – “Gender Affirmation Surgery in Otolaryngology”:
https://www.oto.theclinics.com/issue/S0030-6665(22)X0004-2