Date: March 2022.
Source: Facial Plastic Surgery & Aesthetic Medicine. doi: 10.1089/fpsam.2021.0301. ONLINE.
Background: Gender-affirming facial surgery (GFS) is pursued by transgender individuals who desire facial features that better reflect their gender identity. Currently, there are a few objective guidelines to justify and facilitate effective surgical decision making.
Objective: To quantify the effect of sex on adult facial size and shape through an analysis of three-dimensional (3D) facial surface images.
Materials and Methods: Facial measurements were obtained by registering an atlas facial surface to 3D surface scans of 545 males and 1028 females older than 20 years of age. The differences between male and female faces were analyzed and visualized for a set of predefined surgically relevant facial regions.
Results: On average, male faces are 7.3% larger than female faces (Cohen’s D = 2.17). Sex is associated with significant facial shape differences (p < 0.0001) in the entire face as well as in each sub-region considered in this study. The facial regions in which sex has the largest effect on shape are the brow, jaw, nose, and cheek.
Conclusions: These findings provide biologic data-driven anatomic guidance and justification for GFS, particularly forehead contouring cranioplasty, mandible and chin alterations, rhinoplasty, and cheek modifications.

Article: Sex Differences in Adult Facial Three-Dimensional Morphology: Application to Gender-Affirming Facial Surgery.
Authors: Jordan J Bannister, Hailey Juszczak, Jose David Aponte, David C Katz, P Daniel Knott, Seth M Weinberg, Benedikt Hallgrímsson, Nils D Forkert, Rahul Seth. Department of Biomedical Engineering, University of Calgary, Calgary, Canada; Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology – Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA; Department of Cell Biology and Anatomy, Alberta Children’s Hospital Research Institute and McCaig Bone and Joint Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Oral and Craniofacial Sciences, Center for Craniofacial and Dental Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; and Department of Radiology, Alberta Children’s Hospital Research Institute and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada.