Feminizing the Face: Combination of Frontal Bone Reduction and Reduction Rhinoplasty.

Gender affirmation surgeries in male-to-female patient transitioning include breast augmentation, genital construction, and facial feminization surgery (FFS). FFS improves mental health and quality of life in transgender patients. The nose and forehead are critical in facial attractiveness and gender identity; thus, frontal brow reduction and rhinoplasty are a mainstay of FFS. The open approach to reduction of the frontal brow is very successful in the feminization of the face; however, risks include alopecia and scarring. Endoscopic brow reduction, in properly selected patients, is minimally invasive with excellent outcomes avoiding these risks. Since both reduction rhinoplasty and frontal brow reduction are routinely performed in FFS, a combined approach provides superior control over the nasal radix and profile when performing surgery on the frontal bone region first followed by nose reduction. We present a case series of four transwomen undergoing frontal bone reduction in combination with a reduction rhinoplasty. All had excellent results with one DVT that resolved with treatment. Transgender patients frequently require multiple operations during their transition increasing their hospital stay and costs. This combined approach offers superior control over the nasofrontal angle and is not only safe but reduces hospitalizations and costs and is a novel indication to reduce gender dysphoria.

Pyridinolcarbamate and experimental atherosclerosis. Correlation of hypocholesterolemic and antiatherogenic effects.

Rabbits were maintained for 12 weeks on either a control or hypercholesteremic dietary regime, or on comparable diets supplemented with pyridinolcarbamate (PDC) at a level of 30 mg/kg body weight/day. Blood was obtained from all rabbits prior to study and at two-week intervals for analysis of serum cholesterol, phospholipid phosphorus and triglycerides. Animals from each group were sacrificed at 4-week intervals for quantitative assessment of the degree of atherosclerotic involvement of the aorta. All animals in the four groups consumed their entire daily allowance (100 g) of their respective diets, and weight gains throughout the feeding period were comparable in the 4 groups. PDC given with the control chow diet had no effect on serum cholesterol levels but did result in persistent decrease in serum triglycerides and a variable decrease in serum phospholipids during the 12-week feeding period. None of the rabbits on the chow diet, with or without PDC, had any evidence of aortic lesions during the experimental period. Rabbits fed 1% cholesterol administered with chow exhibited markedly elevated levels of serum cholesterol and phospholipids, while serum triglycerides were not significantly different than in the control group. In these animals there was a rapid and progressive increase in aortic atherosclerosis throughout the study, and at 12 weeks plaque involvement was 74 +/- 8% of the aortic surface. Addition of PDC to the 1% cholesterol--chow diet resulted in significantly lowered levels of serum cholesterol and phospholipids, but these remained elevated compared to the control levels. There was also a dramatic reduction in the rate and extent of aortic plaque formation. Thus, after 12 weeks on diet, only 27 +/- 6% of the aortic surface showed evidence of atheroma. The data suggest that PDC significantly decreases the hypercholesteremia resulting from feeding 1% cholesterol to rabbits, and that this may be largely responsible for the antiatherogenic effect of this drug.

Fine structural changes of the porcine uterine tube epithelium during early and late pregnancy.

Ultrastructural changes in the uterine tube (oviduct) of pregnant gilts have been investigated with special reference to the ciliated, secretory, and stromal cells. Tissue from the uterine tube ampulla and infundibulum was taken from 18 gilts at different stages of gestation (days 31, 36, 101, 102, 107, 110, and 112). Cilia were present throughout pregnancy, and deciliation was not apparent at any stage of gestation. The low epithelium of the uterine tube appeared similar to that of the luteal phase of the estrous cycle when corpora lutea were full grown. Prominent features at end of the gestation were numerous fibrous granules and basal bodies, indicating active formation of ciliary precursor organelles. Fibrogranular aggregates were also present in association with the basal bodies. In addition, numerous polyribosomes, mitochondria, and microtubules were encountered in the cytoplasm of ciliated cells at end of the gestation. The appearance of electron-opaque, fibrous granules during late pregnancy probably could be correlated with increasing endogenous levels of plasma estrogen. Intimate morphologic association between fibrous granules and basal bodies indicate that fibrous granules might provide precursor material for the development of cilia or rootlets. Characteristics ultrastructural changes observed in secretory cells during the estrous cycle were not discernible in secretory cells during pregnancy. The secretory cells appeared similar to those of the luteal phase of the estrous cycle. The apocrine secretory cells contained prominent, apical, cytoplasmic projections; pinching-off process of these protrusions was frequently observed during early and term gestation. Extruded nuclei along with other cytoplasmic organelles were also present, lying free in the tubal lumen. The endoplasmic reticulum was predominantly tubular in form. Synthesis, storage, and release of secretory granules were not apparent at early or late pregnancy. It is suggested that progesterone might have an inhibitory effect on the synthesis, storage, and release of secretory granules. Ultrastructural changes in stromal cells were not apparent at any stage of gestation. The stromal cells appeared similar to that of the luteal phase of the estrous cycle.

Ultrastructural studies of prepubertal porcine uterine tube epithelium.

Ultrastructural details of prepubertal porcine uterine tube (oviduct) were studied in normal, growing gilts and compared with observations reported in other species. Tissues from the ampulla region of uterine tube were taken from 6 prepubertal gilts (106 to 139 days old) to determine cytodifferentiation of ciliated and secretory cells. The epithelium consisted of 2 distinctive cells, the ciliated and the secretory cells. Cilia were observed in the uterine tube of prepubertal gilts; however, degeneration of cilia was not observed in the present study. Most prominent observations were the occurrence of fibrous granules in the apical cytoplasm of ciliated cells. These fibrous granules contained electron-dense material and were present near basal bodies. The most unusual feature was the occurrence of procentrioles around a condensation form. These data indicate that ciliated cells are sensitive to estrogen. Intimate morphologic association between fibrous granules and basal bodies indicate that fibrous granules might provide precursor material for the development of cilia and rootlets. The cytoplasm of the secretory cells contained rough endoplasmic reticulum of tubular form and numerous ribosomes. Evidence for synthesis, storage, and release of secretory granules was not apparent. It is suggested that the secretory cells are not sensitive to the low, circulating concentration of plasma estrogen. The ultrastructure of the stromal cells and lymphatic capillary was described for the 1st time. The uterine tube stromal cells were characterized by prominent nucleus and a few cytoplasmic organelles. The lymphatic capillaries were distinguished by the blood capillaries, their much wider lumen, endothelium with an attenuated cytoplasm, absence of basal lamina, and overlapping and interdigitating intercellular junctions. The fine structure of the porcine uterine tube lymphatic capillary generally resembled that of other mammalian species.

Cyclic ultrastructural changes in ewe uterine tube (oviduct) infundibular epithelium.

Ultrastructural features of the uterine tube (oviduct) infundibulum of ewes have been studied, with special reference to cyclic changes in the ciliated and the secretory cells. Tissue from the uterine tube infundibulum was taken from 12 Rambouillet crossbreed ewes which were killed at intervals (days 1 (or estrus), 3, 9, 10, 12, and 16) throughout the estrous cycle. The presence of cilia was demonstrated throughout the estrous cycle, and true degeneration or loss of cilia was not apparent at any phase of the cycle. Presence of fibrous granules, which are supposedly related to basal body replication, was demonstrated in the apical cytoplasm of ciliated cells on day 1 of the estrous cycle. Small ciliary buds were especially present on day 1, indicating active formation of cilia during the follicular phase of the cycle. The presence of fibrous granules, basal bodies, and ciliary buds at estrus indicates that ciliogenesis in the ewe uterine tube is stimulated by high levels of endogenous estrogen. Rootlets were observed both during the follicular and the luteal phases of the cycle. The rootlets were about 1 mum long, and their fine structure indicates that they might function as anchoring structures for the motile cilia. The most striking feature during estrus was the occurrence of glycogen granules in the cytoplasm of ciliated and secretory cells. These granules were in the apical cytoplasm and basal region of some epithelial cells. They were minimal or absent during the luteal phase of the estrous cycle. The presence of electron-dense glycogen particles was clearly demonstrated within basal bodies. Possibly the glycogen within the basal bodies functions as a source of energy for ciliary movement and the cytoplasmic glycogen as nourishment for the ovum. The secretory cells also showed characteristic cytologic changes which were correlated with the phase of the estrous cycle. Maximal secretory cell differentiation was apparent during the follicular phase, at which time these cells were characterized by well-developed rough endoplasmic reticulum, numerous ribosomes, and secretory granules of varied size, shape, and density. A most remarkable feature of the granules was their membranous structure, consisting of concentric lamellae of equal dimensions. Typical extrusion of secretory granules into the tubal lumen was apparent during the follicular and the luteal phases of the estrous cycle. Cytoplasmic projections containing nuclei protruded into the tubal lumen and some were free in the lumen, especially during the luteal phase of the estrous cycle. The presence of a well-developed endoplasmic reticulum and numerous secretory granules during estrus indicate that secretion in the ewe uterine tube is presumably under the control of circulating high plasma concentrations of estrogen.