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AAPS 2007 Annual Meeting, May 19 - 22, 2007, The Coeur d'Alene Resort, Coeur d'Alene, Idaho.
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Facial Feminization In My First 1000 Male To Female Transsexuals
Douglas K. Ousterhout, MD, DDS.
Douglas K. Ousterhout ,MD, Inc, San Francisco, CA, USA.

Males and females have different bony and soft tissue facial configurations recognized by physical anthropologists. Without knowing why, these differences are part of the reasons we can generally so quickly identify the sex of an individual. If these bony and soft tissue differences in the male are modified through surgical alteration to that of a female, one would hope the result would be female in appearance.
<p>Beginning in 1983 when only one bony procedure was completed (the forehead), the number of procedures was expanded until 1998 when in most adults seven procedures were completed. No additions have been made since then. However, since the beginning, the procedures have been frequently modified, improving the final result towards more femininity. The procedures generally completed involve the scalp, forehead, occasionally the temples, nose, lips, chin, body of the mandible, and the thyroid cartilage. Not all patients need nor want all of these procedures. LeFort Is, mandibular setbacks, otoplasties, cheek augmentations, and submental SALs have also been necessary and completed but are not feminizing.
The patients have been from 17-74 years old with the average being around 47. The first operation, i.e .the bony contouring procedures, is generally from 9.5 to 11.0 hours in length. The patients usually stay two nights in the hospital post operatively. As 95% of the patients come from outside the San Francisco Bay area, they stay 6-8 more days before returning to their state or country. Patients have come from every state in the Union and the great majority of the developed countries of the six inhabited continents.
Preoperatively the great majority have been in good to excellent health but there have been patients with a history of blood clot problems secondary to estrogen (HRT) therapy, multiple cardiac problems (infarcts, etc), kidney transplants, HIV (2%), hepatitis (A, B, and C), multiple GI problems, asthma, and cancers (especially testicular), various post traumatic injuries, etc. Of interest is the unusually high incidence of indirect hernias.
The results have been uniformly feminizing, some would classify as beautiful. The total number of individual surgical procedures completed is over 8000. The patients have generally been maintained on their hormonal replacement therapy (HRT) through the surgery. It generally takes 3-5 months for the swelling to go completely away following the bony surgery and for the final result to be seen. In the older patients, the results of the mandibular contouring are generally not well seen until a rhytidectomy is completed.
Complications have been extremely rare with no major complication including no deaths, myocardial infarctions, strokes, major infections, need for transfusions, emboli or DVT, decubitus ulcers, hematomas, blindness, major allergic reactions, nor wound failures.
The level of patient satisfaction has been fantastic, However, two patients have returned to being a male, in each case more than a year after their surgery, and at least three patients have committed suicide, each more than a year after their feminizing surgery.

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