A Systematic Review and Metanalysis of Anthropometric Facial Variations Among Cisgender Females from Multiple Ethnicities: Implications for Sensitive Approach to Feminizing Facial Gender Affirming Surgery
Keerthi Kurian1, Yvonne Hao1, Daniel Boczar1, Hilliard Brydges1, Augustus Parker1, Bachar Chaya1, Jorge Trilles1, Ricardo Rodriguez Colon1, Eduardo Rodriguez1
1Hansjorg Wyss Department of Plastic Surgery, NYU Langone Health2California Northstate University: College of Medicine
Background: Feminizing Facial Gender Affirming Surgery (FFGAS) is gaining popularity amongst a diverse population of patients impacted by gender incongruence. However, most studies examining facial femininity are based on Caucasians. Thus, it is unclear if ethnic differences exist in anthropometric measures relevant to FFGAS procedures. This study aims to analyze ethnic anthropometric variations in the cisgender female face to identify differences that are potentially relevant to FFGAS.
Methods: A systematic review and meta-analysis of the PubMed, EMBASE, and Cochrane databases was performed following PRISMA guidelines on June 25, 2021. Original studies reporting facial anthropometry in cisgender women were included. Anthropometric measures of interest included mandibular and zygomatic width, face and forehead heights, and nasolabial angle. A meta-analysis was performed using a linear mixed-effects model for each anthropometric measure.
Results: A total of 1246 screened yielding, 24 papers which met inclusion criteria. Facial anthropometric data of 5,096 cis-gender females of 17 different ethnicities were analyzed. This meta-analysis demonstrated that compared to Caucasian cisgender women, Japanese, Chinese, and Korean cisgender women had a wider mandible (Japanese +20.13mm [Standard Error (SE) 4.43, p < 0.001, p-value adjusting for multiple comparison (p-adj) = 0.002], Chinese +16.22mm [SE 4.39, p = 0.002, p-adj = 0.013]; and Korean +14.46mm [SE 3.97, p = 0.002, p-adj = 0.014]). Further, when compared to Caucasian cisgender women, Chinese cisgender women demonstrated larger zygomatic width, African American cisgender women tended to have smaller nasolabial angles and Indian and Japanese cisgender women tended to have smaller and larger face heights respectively. However, following p-value adjustment for multiple comparisons, these differences were found to no longer be statistically significant.
Conclusions: This study found mandibular width to be greater for Japanese and Chinese cisgender women when compared to Caucasian cisgender women. One possible use for data such as these is in counseling patients during preoperative evaluations, for mandibular reduction. All other anthropometric features were found to be not statistically different among ethnic groups. This portends that current approaches to FFGAS which emphasize patient-specific needs and maintenance of a harmonious appearance may require minimal or no adjustment to account for ethnic anthropometric differences.
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