Feminization and masculinization facial surgeries: forensic repercussions

Authors

DOI:

https://doi.org/10.33448/rsd-v10i13.20877

Keywords:

Forensic Anthropology; Forensic Dentistry; Identification of Victims; Feminization and Masculinization; Transgender persons.

Abstract

Individuals who are characterized by strong and persistent identification with the opposite sex (gender dysphoria) often seek plastic surgeons for sex reassignment and/or to accentuate gender-specific facial features, surgically modifying facial features, wishing to be accepted in society as part of antagonistic sex. Surgical procedures aimed at modifying and reconstructing facial bone characteristics, as well as soft tissues, are being performed to make the face of trans women more feminine (facial feminization surgery) and trans men more masculine (facial masculinization). These procedures may have forensic consequences, due to difficulties in estimating the sex, with regard to the possible need for recognition of the individual through Forensic Facial Reconstruction, and consequently, in identifying people who have undergone this type of surgery. Such consequences, although important, are little considered in scientific studies. Thus, this study brings a theoretical and reflective approach to forensic aspects and considerations in human recognition and identification of transsexual individuals who underwent feminization to masculinization facial surgeries.

References

Ainsworth, T. A & Spiegel, J. H. (2010). Quality of life of individuals with and without facial feminization surgery or gender reassignment surgery. Qual Life Res., 19, 1019-24.

Altman, K. (2012). Facial feminization surgery: current state of the art. International Journal of Oral and Maxillofacial Surgery, 41(8), 885-894.

American Society of Plastic Surgeons. (2021). Facial Masculinization Surgery - Female to Male - the goal of facial Masculinization Surgery is to transform the feminine features of the face to a more masculine appearance. https://www.plasticsurgery.org/reconstructive-procedures/facial-masculinization-surgery

Aulsebrook, W. A., Becker, P. J. & Işcan, M. Y. (1996). Facial soft-tissue thicknesses in the adult male Zulu. Forensic Sci Int., 79 (2), 83- 102.

Aulsebrook, W. A., Işcan, M. Y., Slabbert, J. H. & Becker, P. (1995). Superimposition and reconstruction in forensic facial identification: a survey. Forensic Sci Int., 75(2–3), 101–20.

Balaji, S. M. (2016). Facial feminization. Ann Maxillofac Surg., 6(2), 158.

Barros, F., Fernandes, C. M. S., Kuhnen, B., Scarso Filho, J., Gonçalves, M., & Serra, M. C. (2021)a. Paranasal sinuses and human identification. Research, Society and Development, 10(9), e48710918161.

Barros, F., Serra, M. C., Kuhnen, B., Matos, R. A. & Fernandes, C. M. S. (2021)b. Orthodontic 2D and 3D frontal sinus imaging records: an important role in human identification. Research, Society and Development, 10(13), e49110313608.

Barros, F., Serra, M. C., Kuhnen, B., Scarso Filho, J., Gonçalves, M., & Fernandes, C. M. S. (2021)c. Midsagittal and bilateral facial soft tissue thickness: a Cone - Beam Computed Tomography assessment of Brazilian living adults. Forensic Imaging. 200444.

Becking, A. G., Tuinzing, D. B., Hage, J. J. & Gooren, L. J. (1996). Facial corrections in male to female transsexuals: a preliminary report on 16 patients. J Oral Maxillofac Surg., 54(4), 413-8.

Becking, A. G., Tuinzing, D. B., Hage, J. J. & Gooren, L. J. (2007). Transgender feminization of the facial skeleton. Clin Plast Surg., 34(3), 557-564.

Buchanan, S. (2014). Bone Modification in Male to Female Transgender Surgeries: Considerations for the Forensic Anthropologist. Dissertação. Faculdade de Agricultura e Mecânica. Louisiana State University.

Bulut, O., Sipahioglu, S. & Hekimoglu, B. (2014). Facial soft tissue thickness database for craniofacial reconstruction in the Turkish adult population. Forensic Sci Int., 242, 44–61.

Byers, S. N. (2017). Introduction to forensic anthropology (5th ed.). Routledge.

Canner, J. K., Harfouch, O., Kodadek, L. M., Pelaez, D., Coon, D., Offodile, A. C., Haider, A. H. & Lau, B. D. (2018). Temporal Trends in gender-affirming surgery among transgender patients in the United States. JAMA Surg., 153, 609–616.

Capitán, L., Simon, D., Kaye, K. & Tenorio, T. (2014). Facial feminization surgery: The forehead. Surgical techniques and analysis of results. Plast Reconstr Surg., 134, 609-19.

Carvalho, S. P. M., Da Silva, R. H. A., Lopes-Júnior, C. & Peres, A. S. (2009). A utilização de imagens na identificação humana em odontologia legal*. Radiol Bras., 42(2), 125–130.

Cavanagh, D. & Steyn, M. (2011). Facial reconstruction: soft tissue thickness values for South African black females. Forensic Sci Int., 206(1-3), e1-215.e7.

Champod, C. & Meuwly, D. The inference of identity in forensic speaker recognition. Speech Communication, 31(2-3), 193-203.

Codinha, S. (2009). Facial soft tissue thicknesses for the Portuguese adult population. Forensic Sci Int., 184(1-3), 80.

Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P. T., DeCuypere, G., Feldman, J., Fraser, L., Green, J., Knudson, G.,Meyer, W. J., Monstrey, S., Adler, R. K., Brown, G. R., Devor, A. H., Ehrbar, R., Ettner, R., Eyler, E., Garofalo, R., Karasic, D. H., Lev A. L., Mayer, G., Meyer-Bahlburg, H., Hall, B. P., Pfaefflin, F., Rachlin, K., Robinson, B., Schechter, L. S., Tangpricha, V., Trotsenburg, M. V., Vitale, A., Winter, S., Whittle, S., Wylie, K. R. & EK. Zucker, E. K. (2012). Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. Int J Transgend., 13, 165-232.

Defreyne, J., Motmans, J. & T'Sjoen, G. (2017). Healthcare costs and quality of life outcomes following gender affirming surgery in trans men: a review. Expert Rev Pharmacoecon Outcomes Res ., 17, 543–556.

Deschamps-Braly, J., Sacher, C., Fick, J. & Ousterhout, D. (2017). First Female-to-Male Facial Confirmation Surgery with Description of a New Procedure for Masculinization of the Thyroid Cartilage (Adam’s Apple). Plastic and Reconstructive Surgery, 139(4), 883e–887e.

Deschamps-Braly, J. C. (2018). Facial Gender Confirmation Surgery: Facial Feminization Surgery and Facial Masculinization Surgery. Clin Plast Surg., 45(3), 323-331.

Deschamps-Braly, J. C. (2019). Approach to Feminization Surgery and Facial Masculinization Surgery: Aesthetic Goals and Principles of Management. Journal of Craniofacial Surgery, 30(5), 1352-1358.

Dhingra N, Bonati LM, Wang EB, Chou M, Jagdeo J. (2019)Medical and aesthetic procedural dermatology recommendations for transgender patients undergoing transition. J Am Acad Dermatol., 80:1712–1721.

Domaracki, M. & Stephan, C. N. (2006). Facial soft tissue thicknesses in Australian adult cadavers. J Forensic Sci., 51(1), 5-10.

Dong, Y., Huang, L., Feng, Z., Bai, S., Wu, G. & Zhao, Y. (2012). Influence of sex and body mass index on facial soft tissue thickness measurements of the northern Chinese adult population. Forensic Sci Int., 222(1-3), 396.

Drgáčová, A., Dupej, J. & Velemínská, J. (2016). Facial soft tissue thicknesses in the present Czech Population. Forensic Sci Int., 260, 106.e1-106.e7.

El-Mehallawi, I. H. & Soliman, E. M. (2001). Ultrasonic assessment of facial soft tissue thicknesses in adult Egyptians. Forensic Sci. Int., 117(1-2), 99–107.

Evison, M. P., Finegan, O. M. & Blythe, T. C. (1998). Computerised 3-D facial reconstruction: research update. https://www.researchgate.net/publication/276025876_Computerised_3-D_facial_reconstruction_research_update.

Facque, A. R., Atencio, D. & Schechter, L. S. (2019). Anatomical Basis and Surgical Techniques Employed in Facial Feminization and Masculinization. Journal of Craniofacial Surgery, 30(5), 1406-1408.

Fernandes, C. M. S. (2010). Análise das reconstruções faciais forenses digitais caracterizadas utilizando padrões de medidas lineares de tecidos moles da facede brasileiros e estrangeiros. Tese. Universidade de São Paulo, São Paulo, Brasil.

Fernandes, C. M. S., Serra, M. C., Silva, J. V. L., Noritomi, P. Y., Pereira, F. D. S. & Melani, R. F. H. (2012). Tests of one Brazilian facial reconstruction method using three soft tissue depth sets and familiar assessors. Forensic Sci Int., 214(1-3), 211e1-7.

Fernandes, C. M. S., Pereira, F. D. S., Silva, J. V. L. & Serra, M. C. (2013) Is characterizing the digital forensic facial reconstruction with hair necessary? A familiar assessors’ analysis. Forensic Sci. Int. 229 (1–3), 164.e1–164.e5.

Fisher, M., Lu, S. M., Chen, K., Zhang, B., Maggio, MD. & Bradley, J. P. (2020). Facial Feminization Surgery Changes Perception of Patient Gender. Aesthetic Surgery Journal, 40(7), 703–709.

Fourie, Z., Damstra, J., Gerrits, P. O. & Ren, Y. (2010). Accuracy and reliability of facial soft tissue depth measurements using cone beam computer tomography. Forensic Sci Int., 199(1-3), 9-14.

França, G. V. Medicina Legal. Guanabara Koogan.

Frari, P., Iwashita, A. R., Caldas, J. C. F. G., Scanavin, M. A. & Júnior, E. D. (2008). A importância do odontolegista no processo de identificação humana de vítima de desastre em massa. Sugestão de protocolo de exame técnico-pericial. Revista Odonto., 16(31), 38-44.

Garlie, T. N. & Saunders, S. R. (1999). Midline facial tissue thicknesses of subadults from a longitudinal radiographic study. J Forensic Sci., 44(1), 61-7.

Geller, P. L. (2005). Skeletal analysis and theoretical complications. World Archaeology, 47(4), 597-609.

Ginsberg, B. A. (2017). Dermatologic care of the transgender patient. Int J Womens Dermatol., 3(1), 65–67.

Gioster-Ramos, M. L., Silva, E. C. A., Nascimento, C. R., Fernandes, C. M. S. & Serra, M. C. (2021) Técnicas de identificação humana em Odontologia Legal. Research, Society and Development, 10(3), e20310313200.

Greef, S., Claes, P., Vandermeulen, D., Mollemans, W., Suetens, P. & Willems, G. (2006). Large-scale in-vivo Caucasian facial soft tissue thickness database for craniofacial reconstruction. Forensic Sci Int., 15, 159 Suppl 1, S126-46.

Guyomarc'h, P., Santos, F., Dutailly, B. & Coqueugniot, H. (2013). Facial soft tissue depths in French adults: variability, specificity and estimation. Forensic Sci Int., 231(1–3), 411.

Haas, A. P., Rodgers, P. L. & Herman, J. L. (2014). Suicide attempts among transgender and gender non-conforming adults: findings of the national transgender discrimination survey. American Foundation for suicide prevention. 1-18.

Habal, M. B. (1990). Aesthetics of feminizing the male face by craniofacial contouring of the facial bones. Aesthetic Plast Surg., 14(2), 143-150.

Haresh, A. D., Singh, P. & Song, J. (2015). Soft tissue thickness determination using CBCT in diverse medical disciplines. J Pharm Biomed Sci., 5(12), 967–72.

Herrera, L. M., Strapasson, R. A. P., Zanin, A. A., da Silva, J. V. L. & Melani, R. F. H. (2017). Comparison among manual facial approximations conducted by two methodological approaches of face prediction. J Forensic Sci., 62(5), 1279–85.

Holobinko, A. (2012). Forensic human identification in the United States and Canada: A review of the law, admissible techniques, and the legal implications of their application in forensic cases. Forensic Science International, 222, 394.e1–394.e13

Hu, K. S., Koh, K. S., Han, S. H., Shin, K. J., Kim, H. J. (2006). Sex Determination Using Nonmetric Characteristics of the Mandible in Koreans. J Forensic Sci., 51(6), 1376-1382.

Interpol. (2018). Disaster Victim Identification Guide. https://www.interpol.int/How-we-work/Forensics/Disaster-Victim-Identification-DVI

Ìşcan, M. Y. (2005). Forensic anthropology of sex and body size. Forensic Sci Int., 147(2), 107-112.

Jeelani, W., Fida, M. & Shaikh, A. (2015). Facial Soft Tissue Thickness Among Three Skeletal Classes in Adult Pakistani Subjects. J Forensic Sci., 60(6), 1420-5.

Jones, G. (2014). Not a yes or no question: critical perspectives on sex and gender in forensic anthropology. Dissertation. University of Windsor, Canada.

Kamol Hospital - Thailand Cosmetic & Plastic Surgery. Facial Masculinization Surgery (FMS). (2020).

https://www.kamolhospital.com/en/service/female-to-male-surgery/

Kanchan, T. & Krishan, K. Personal Identification in Forensic Examinations. Anthropol., 2, 114. 2013.

Killermann, S. (2014). Breaking through the binary: Gender explained using continuum. Its Pronounced Metrosexual. https://www.itspronouncedmetrosexual.com/ 2011/11/breaking-through-the-binary-genderexplained-using-continuums/

Kim, Y. J, Park, J. W., Kim, J. M., Park, S. H,, Hwang, J. H., Kim, K. S., Lee, S. Y. & Shin, J. H. (2013). The Functionality of Facial Appearance and Its Importance to a Korean Population. Arch Plast Surg., 40(6), 715–720.

Kuhnen, B., Barros, F., Fernandes, C. M. S. & Serra, M. C. (2020). Cirurgia de feminização facial em transexuais: reflexões éticas e forenses. Rev. Bioét., 28(3), 432-9.

Kuhnen, B., Fernandes, C. M. S., Barros, F., Scarso Filho, J., Gonçalves, M., & Serra, M. C. (2021). Facial soft tissue thickness of Brazilian living subadults. A Cone-Beam Computed Tomography study. Forensic Imaging. 200434.

Lai, Y. C., Kazlouskaya, M. & Kazlouskaya, V. (2020). Historical and current state of dermatologic care for sexual and gender minority populations. Dermatol Clin., 38(2), 177–183.

Lents, L. H. The Stunning Diversity of Human Faces. (2014). The Human Evolution Blog. https://thehumanevolutionblog.com/2014/10/01/the-stunning-diversity-of-human-faces/.

Li, J., Hsu, Y., Khadka, U. M. A., Hu, J., Wang, Q. & Wang, D. (2012). Surgical designs and techniques for mandibular contouring based on categorisation of square face with low gonial angle in orientals. J Plast Reconstr Aesthet Surg., 65(1), e1-e8.

Luo, L., Wang, M., Tian, Y., Duan, F., Wu, Z., Zhou, M., & Rozenholc, Y. (2013). Automatic sex determination of skulls based on a statistical shape model. Computational and Mathematical Methods in Medicine, 251628.

McNeill, D. (1998). The face: A natural History. New York. Little, Brown.

Moore, H. L. (2003). Understanding sex and gender. In T. Ingold (Eds.), Companion encyclopedia of anthropology: Humanity, culture and social life.Routledge.

Morrison, S.D., Vyas, K.S., Motakef, S., Gast, K.M., Chung, M.T., Rashidi, V., Satterwhite, T., Kuzon, W. & Cederna, P.S. (2016). Facial feminization: systematic review of the literature. Plast Reconstr Surg., 137, 1759–1770.

Neves, I. S. R., Santiago, A. P. A. C. e. S., Silva, M. I. T., & Oliveira, E. R. M. (2021). Rugoscopia palatina e seus desafios na identificação humana: Uma revisão integrativa. Research, Society and Development, 10(4).

Newman, T., & Cross, K. (2018). Sex and gender: What is the difference? Medical News Today. https://www.medicalnewstoday.com/articles/ 232363#gender-differences

Ousterhout, D. & Deschamps-Braly, J. (2019). Special edition of transgender facial surgery. J Craniofac Surg., 30, 1326–1327.

Ousterhout, D. K. (1987). Feminization of the forehead: contour changing to improve female aesthetics. Plast Reconstr Surg., 79(5), 701-713.

Ousterhout, D. K. (2011). Dr. Paul Tessier and facial skeletal masculinization. Ann Plast Surg., 67(6), S10-5.

Pereira, A. S., Shitsuka, Dorlivete Moreira Parreira, F. J. & Shitsuka, R. (2018). Metodologiada Pesquisa Científica - Licenciatura em Computação. https://repositorio.ufsm.br/bitstream/handle/1/15824/Lic_Computacao_Metodologia-Pesquisa-Cientifica.pdf?sequence=1.

Plemons, E. D. (2012). Making the Gendered Face: The Art and Science of Facial Feminization Surgery. Dissertation. University of California, Beckley.

Plemons, E. D. (2014). Description of sex difference as prescription for sex change: On the origins of facial feminization surgery. Social Studies of Science, 44(5), 657–679.

Plemons, E. D. (2017). Formations of Femininity: Science and Aesthetics in Facial Feminization Surgery. Medical Anthropology, 36, 7, 629-641.

Prajapati,G., Sarode, S. C., Sarode, G. S., Shelke, P., Awan, K. H. & Patil, S. (2018). Role of forensic odontology in the identification of victims of major mass disasters across the world: A systematic review. PLOS ONE 13(6): e0199791.

Rhine, J. S. & Campbell, H. R. (1980). Thickness of facial tissues in American blacks. J Forensic Sci., 25 (4), 847-58.

Rhine, J. S. & Moore, C. E. (1984) Tables of facial tissues thickness of American Caucasoids in forensic anthropology. Maxwell Museum Tech Ser.

Sahni, D., Sanjeev, Singh, G., Jit, I. & Singh, P. (2008). Facial soft tissue thickness in northwest Indian adults. Forensic Sci Int., 176(2-3), 137-46.

Saini, V., Srivastava, R., Rai, R. K., Shamal, S. N., Singh, T. B. & Tripathi, S. K. (2011). Mandibular Ramus: An Indicator for Sex in Fragmentary Mandible. J Forensic Sci., 56(s1), S13-S6.

Sanders, R. (2014). Human faces are so variable because we evolved to look unique. Politics & Society, Research, Science & Environment. Berkeley News.

https://news.berkeley.edu/2014/09/16/human-faces-are-so-variable-because-we-evolved-to-look-unique/.

Santos, A. N., Falcão, T. N., Lima, L. N. C., Vieira, T. I., & Santiago, B. M. (2021). A Queiloscopia como técnica de identificação humana: Uma revisão sistemática da literatura. Research, Society and Development, 10 (8).

Santos, W. D. F., Diniz, P. R. B., Santos, A. C., Martin, C. C. S. & Guimarães, M. A. (2008). Definições de pontos craniométricos em imagens multiplanares de ressonância magnética (RM) para fins de reconstrução facial forense. Medicina Ribeirão Preto, 41 (1), 17-23.

Sayegh, F. B. A., Ludwig, D. C., Ascha, M., Krishna, V., ShakiR, A., Kwong, J. W., Swanson, M., Evans, M. W., Gatherwright, J. & Morrison, D. Facial Masculinization Surgery and its Role in the Treatment of Gender Dysphoria. Journal of Craniofacial Surgery, 30(5), 1339-1346.

Schall, J. L., Rogers, T. L., & Deschamps-Braly, J.C. (2020). Breaking the binary: The identification of trans-women in forensic anthropology. Forensic Science International, 309, 110220.

Shaffer, J. R., Orlova, E., Lee, M. K., Leslie, E. J., Raffensperger, Z. D., Heike, C. L., Cunningham, M. L., Hecht, J. T., Kau, C. H., Nidey, N. L., Moreno, L. M., Wehby, G. L., Murray, J. C., Laurie, C. A., Laurie, C. C., Cole, J., Ferrara, T., Santorico, S., Klein, O., Mio, W., Feingold, E., Hallgrimsson, B., Spritz, R. A., Marazita, M. L. & Weinberg, S. M. (2016). Genome-Wide Association Study Reveals Multiple Loci Influencing Normal Human Facial Morphology. PLoS Genet., 12(8), e1006149.

Shams, M. G. & Motamedi, M. H. K. (2009). Case Report: Feminizing the Male Face. Eplasty., 9, e2.

Shapiro, J. (1981). Anthropology and the study of gender. Soundings: An Interdisciplinary Journal, 64(4), 446-465.

Silva, M. C. (2019). The increasing role of forensic anthropology in the investigation of missing persons, unidentified remains, and cold cases. Thesis. Tulane University, Nova Orleans, Luisiana.

Simpson, E. & Henneberg, M. (2002). Variation in soft-tissue thicknesses on the human face and their relation to craniometric dimensions. Am J Phys Anthropol., 118(2), 121-33.

Spiegel, J. H. (2008). Challenges in Care of the Transgender Patient Seeking Facial Feminization Surgery. Facial Plastic Surgery Clinics of North America, 16(2), 233-238.

Statistics Canada. (2020). Sex at birth and gender: Technical report on changes for the 2021 census.

https://www12.statcan.gc.ca/censusrecensement/2021/ref/98-20- 0002/982000022020002-eng.cfm

Teixeira, J. C., Morrison, S. D., Brandstetter, K. A. & Nuara, M. J. (2020). Is There an Increasing Interest in Facial Feminization Surgery? A Search Trends Analysis. J Craniofac Surg., 31(3), 606-607.

Telang, P.S. (2020). Facial Feminization Surgery: A Review of 220 Consecutive Patients. Indian J Plast Surg., 53(2), 244–253.

The International Center - for transgender care. Facial Masculinization Surgery FMS. https://thetranscenter.com/transmen/facial-masculinization-surgery-fms/

Thiemann, N., Keil, V. & Roy, U. (2017). In vivo facial soft tissue depths of a modern adult population from Germany. Int J Legal Med,. 131(5), 1455–1488.

Tilotta, F., Richard, F., Glaunès, J., Berar, M., Gey, S., Verdeille, S., Rozenholc, Y. & Gaudy, J. F. (2009). Construction and analysis of a head CTscan database for craniofacial reconstruction. Forensic Sci Int., 191(1-3), 112.

Tugnet, N., Goddard, J.C., Vickery, R.M., Khoosal, D. & Terry, T.R. (2007). Current management of male-to-female gender identity disorder in the UK. Postgrad Med J., 83, 638-42.

Utsuno, H., Kageyama, T., Uchida, K., Yoshino, M., Oohigashi, S., Miyazawa, H. & Inoue, K. (2010). Pilot study of facial soft tissue thickness differences among three skeletal classes in Japanese females. Forensic Sci Int., 195(1–3), 1–5.

Veríssimo, M. H. G., Rodrigues, M. A., Nóbrega, W. F. S., Barbosa, D. V., Neto, O. M. M., Dias, B. A. S., & Silva, G. C. B. . (2021). O conhecimento da anatomia versus a Odontologia Legal: Uma revisão integrativa sobre o processo de identificação humana. Research, Society and Development, 10 (7).

Verzé, L. History of facial reconstruction. (2009). Acta Biomed., 80(1), 5-12.

Wilkinson, C. (2010). Reconstrução facial - arte anatômica ou anatomia artística?. Journal of anatomy, 216 (2), 235-250.

Zilio, F., Basualdo, A. & Cruz, R. A. (2004). Meios de identificação odontolegal. https://www.imed.edu.br/Uploads/66fd6950-4925-442f-a7ba-03007be1b860.pdf.

Published

10/10/2021

How to Cite

BARROS, F. de .; SERRA, M. da C.; KUHNEN, B.; FERNANDES, C. M. da S. Feminization and masculinization facial surgeries: forensic repercussions. Research, Society and Development, [S. l.], v. 10, n. 13, p. e201101320877, 2021. DOI: 10.33448/rsd-v10i13.20877. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/20877. Acesso em: 2 dec. 2021.

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Health Sciences