Facial Feminization Surgery: Preoperative Planning and Surgical Technique for a Harmonious Outcome.

Feminization of the face is as important as genital or chest surgeries in alleviating gender incongruence in transgender individuals. It comprises a myriad of procedures that address the skeletal and/or soft tissue components to give a harmonious result. The surgeries are custom-tailored for each individual based on facial anatomy as well as her desired changes for optimal results. A thorough understanding of the differences in male and female facial anatomy is crucial. The use of computed tomographic imaging with three-dimensional reconstruction and stereolithography models can greatly improve the planning as well as execution of these surgeries. There is an increase in demand for these surgeries, with a paucity of centers providing them. The aim of this article is to highlight the comprehensive facial feminization procedures, which have a high patient as well as surgeon satisfaction rate.

Ameliorative Effect of Neem Leaf and Pomegranate Peel Extracts in Coccidial Infections in New Zealand and V-Line Rabbits: Performance, Intestinal Health, Oocyst Shedding, Carcass Traits, and Effect on Economic Measures.

Healthy, weaned, coccidial-free male rabbits from two breeds (New Zealand white (NZ) and V-line (VL)) were divided into 10 equal groups (5 groups each for NZ and VL) (3 replicates/group, 6 rabbits/replicate, 18 rabbits/group). All rabbits were inoculated with 5 × 104 Eimeria spp. oocysts (E. intestinalis (67%), E. magna (22%), and E. media (11%)) except for the rabbits in the first group (G1), which were inoculated with a sterile solution and served as a negative control. The remaining four groups were treated as follows: G2, no treatment/positive control, G3, treated with neem leaf extract, G4, treated with pomegranate peel extract (PPE), and G5, treated with a combination of neem leaf extract and PPE. For both breeds, our results showed that the use of neem leaf and/or pomegranate peel extract resulted in improved growth performance, with a significant improvement in relative feed conversion ratio (FCR) compared to the positive control groups, which recorded the worst values, as well as a significant (p ≤ 0.05) reduction in mean oocyst count compared to the positive control groups. We also observed downregulation of mRNA levels of IL-1ßα, IL6, and TNF-α in the herbal treatment groups compared with the mRNA levels of these genes in the positive control groups. Herbal treatment with neem leaf and/or pomegranate peel extracts had positive effects on the NZ and VL rabbits experimentally infected with mixed Eimeria species, as evidenced by their healthy appearance, good appetite, no mortalities, an anticoccidial index > 120, and a significantly higher total return and net profit when compared to the positive control groups of both breeds. In NZ rabbits, the treatment with neem leaf extract alone (G3) or in combination with PPE (G5) recorded the most efficient economic anticoccidial activity.

Effect of Biologically Treated Wheat Straw with White-Rot Fungi on Performance, Digestibility and Oxidative Status of Rabbits.

BACKGROUND AND OBJECTIVE: Raising growing rabbits is an ideal solution to confront animal protein deficiency, especially in developing countries. The presence of lignin in wheat straw causes limitation of the digestion overall process. The biological delignification is a practical and promising alternative due to improving the digestibility of wheat straw. This study aimed to enhance wheat straw digestibility and enriching it with protein and use it as a growing rabbit feedstuff. MATERIALS AND METHODS: Enzymes production of white-rot fungi was assayed in myco-straw and the mean value was recorded. Wheat straw has been treated with the three most effective fungal species with Biological Treated Wheat Straw (BTWS). After that, the myco-straw was grounded and included in diet to evaluate the growth performance, digestibility and blood parameters of a growing V-line rabbit. RESULTS: The best three species for enzyme productions were P. sajor-caju, P. columbinus and P. floridanus. The optimum incubation period was 16 days. The fungal treatments showed significant enzymes activity of laccase, Mn-peroxidase, cellulase and xylanase. Body weight, body weight gain and feed conversion ratio of growing V-line rabbits had improved than those of the control. But, nutrients digestibility of the diet containing BTWS and Carcass traits of growing V-line rabbits were non-significant compared with the control one. In comparison with control, the lipid profile had no differences but the total protein was improved. CONCLUSION: White-rot fungal conversion of wheat straw is maybe one potential alternative providing a more practical, environmental-friendly and nutritionally enhancing as rabbits feedstuff. Rabbits fed BTWS-diets had significantly improved growth performance.

Facial Feminization Surgery: A Review of 220 Consecutive Patients.

Background Facial feminization surgery (FFS) is a combination of facial bony and soft tissue surgeries designed to modify and convert a masculine face to feminine. One's face plays a very central role in gender incongruence and FFS helps patients overcome this. There are prominent differences between the male and the female facial anatomy (bony and soft tissue) which can be surgically altered to change the visual perception of the face. Methods The author presents the method used at his center for treating 220 patients of gender incongruence requesting FFS from June 2016 to June 2019. The alterations to known methods of forehead contouring, hairline lowering, and jaw shave adopted by his team are discussed. He also presents the logic of performing the entire FFS in two stages at an interval of 7 to 10 days. Results A total of 220 cases of FFS are presented, along with surgical details of techniques used, the sequence and staging of procedures performed, and the results obtained. A two-staged approach to FFS is proposed to maximize the recovery and minimize complications and promote faster healing. Different methods of forehead contouring are also explained in detail. Conclusions FFS is a very rewarding surgery for the plastic surgeon and has high patient satisfaction rate. With proper training in craniomaxillofacial and soft tissue surgery, it is possible for the plastic surgeon to be the main team leader for this procedure. A two-stage approach is highly recommended.

Association of single-nucleotide polymorphism of melanocortin gene with feed intake in rabbit (Oryctolagus cuniculus).

The aim of the study was to investigate the association of two parts of melanocortin gene (MC4R-1, MC4R-2) and feed intake for V-line rabbits. V-line rabbits were grouped into high and low daily feed intake during the period from 30 to 63 days of age in order to identify MC4R SNPs useful for association study with feed intake. DNA from blood samples of each group was extracted to amplify the MC4R gene. The purified PCR products were sequenced in those had the highest and lowest feed intake. Alignment of sequence data from each group revealed that there is a variation detected in MC4R-1 at nucleotide 35 (T-G) (sense mutation) and another variation was detected in MC4R-2 gene at nucleotide 19 (T-C) (sense mutation) for high feed intake rabbits. These sense mutations lead to transform some amino acids and cause a significant change of the MC4R function. The results of average daily feed intake (ADFI) indicated that group (1) had significantly higher feed intake than group (2) of V-line rabbits. The detected mutations and the analysis of daily feed intake means revealed a significant association between MC4R polymorphism and feed intake in rabbits.

Comparison of milk production and milk composition for an exotic and a local synthetic rabbit lines.

AIM: Basic objective of this research was to compare two rabbit lines: V-line (exotic line), Alexandria (local synthetic line) for yield and composition of milk product and their effect on productive performance of rabbits. MATERIALS AND METHODS: The experiment was conducted on 80 does and their kits. Milk yield (MY) of each doe and milk composition (MC) were recorded at 3rd week of lactation. RESULTS: The results of MY showed insignificant difference between V-line and Alexandria line. While the results of MC indicated significant differences in milk protein and fat between the two lines. The protein electrophoresis was used for assaying variation in milk proteins between the two lines. The banding protein patterns showed seven protein bands for Alexandria line and six bands for V line. The results demonstrated one specific protein marker at 48 KDa (κ-casein) in Alexandria doe's milk. Moreover, the results of individual body weight at weaning age indicated that Alexandria rabbits had significantly higher body weight compared with V-line rabbits (845.33 g, 664.05 g, respectively). Alexandria line had significantly lower mortality rate compared with V-line (1.5%, 2.7%, respectively). CONCLUSION: The differences which obtained in Alexandria line milk may play an important role in the productive performance of rabbits.

A safe and accurate method to perform esthetic mandibular contouring surgery for Far Eastern Asians.

A tapered mandibular contour is popular with Far Eastern Asians. This study describes a safe and accurate method of using preoperative virtual surgical planning (VSP) and an intraoperative ostectomy guide to maximize the esthetic outcomes of mandibular symmetry and tapering while mitigating injury to the inferior alveolar nerve (IAN). Twelve subjects with chief complaints of a wide and square lower face underwent this protocol from January to June 2015. VSP was used to confirm symmetry and preserve the IAN while maximizing the surgeon's ability to taper the lower face via mandibular inferior border ostectomy. The accuracy of this method was confirmed by superimposition of the perioperative computed tomography scans in all subjects. No subjects complained of prolonged paresthesia after 3 months. A safe and accurate protocol for achieving an esthetic lower face in indicated Far Eastern individuals is described.

Three-dimensional morphometric analysis of mandibule in coronal plane after bimaxillary rotational surgery.

BACKGROUND: The aim of this report is to present a new reference for aesthetic mandible surgery using three-dimensional cone-beam computed tomography-based treatment planning for orthognathic surgery which can be implemented in surgical planning and perioperative procedure. METHODS: To make an objective standard for evaluating aesthetic mandibular outline, we make an aesthetic scoring criteria with consideration of asymmetry, broad mandibular border line, and prominent mandibular angle. Two maxillofacial surgeons and two orthodontists rated their aesthetical evaluation from 1 to 5. Experimental group consisting of 47 female and 38 male patients who had rotational orthognathic two-jaw surgery from 2010 to 2011 were chosen according to aesthetic scoring done by two maxillofacial surgeons and two orthodontists. A high aesthetic score (≥16) means the facial contour is symmetric, with no broad and narrow aesthetic mandible frontal profiles. Control A group consisted of ten female and ten male patients who had no orthognathic surgery experience and low aesthetic score (≤10). Control B group consisted of ten female and ten male patients who had no orthognathic surgery experience and had anaesthetic mandibular frontal profile and a high aesthetic score (≥16). The three-dimensional image of the patient was taken from dental cone-beam CT (DCT) scanning (experimental group and control A group: 6 months DCT after surgery, control B group: 1st visit DCT). Each DCT was reformatted to reorient the 3D image using 3D analyzing program (OnDemand3D, cybermed Inc, CA, USA). After selection of 12 landmarks and the construction of reoriented horizontal, vertical, and coronal reference lines, 15 measurements were taken in 3D analysis of frontal mandibular morphology. Afterwards, horizontal and vertical linear measurements and angular measurements, linear ratio were obtained. RESULTS: Mean Go'Rt-Me'-Go'Lt angular measurement was 100.74 ± 2.14 in female patients and 105.37 ± 3.62 in male patients. These showed significant difference with control A group in both genders. Ratio of Go'Rt,Go'Lt-Me' length to some linear measurements (ratio of Me'-Cd'RtCd'Lt to Me'-Go'RtGo'Lt, ratio of Me'-Go' to Me'-Go'RtGo'Lt, ratio of Go'Rt-Go'Lt to Me'-Go'RtGo'Lt) showed significant difference with control A group in both genders. CONCLUSION: This study was intended to find some standard measurement of mandible frontal view in 3D analysis of aesthetic patient. So, these potential measurement value may be helpful for orthognathic treatment planning to have more aesthetic and perspective outcomes.

Three-dimensional morphometric analysis of mandibule in coronal plane after bimaxillary rotational surgery / 대한악안면성형재건외과학회지

BACKGROUND: The aim of this report is to present a new reference for aesthetic mandible surgery using three-dimensional cone-beam computed tomography-based treatment planning for orthognathic surgery which can be implemented in surgical planning and perioperative procedure. METHODS: To make an objective standard for evaluating aesthetic mandibular outline, we make an aesthetic scoring criteria with consideration of asymmetry, broad mandibular border line, and prominent mandibular angle. Two maxillofacial surgeons and two orthodontists rated their aesthetical evaluation from 1 to 5. Experimental group consisting of 47 female and 38 male patients who had rotational orthognathic two-jaw surgery from 2010 to 2011 were chosen according to aesthetic scoring done by two maxillofacial surgeons and two orthodontists. A high aesthetic score (≥16) means the facial contour is symmetric, with no broad and narrow aesthetic mandible frontal profiles. Control A group consisted of ten female and ten male patients who had no orthognathic surgery experience and low aesthetic score (≤10). Control B group consisted of ten female and ten male patients who had no orthognathic surgery experience and had anaesthetic mandibular frontal profile and a high aesthetic score (≥16). The three-dimensional image of the patient was taken from dental cone-beam CT (DCT) scanning (experimental group and control A group: 6 months DCT after surgery, control B group: 1st visit DCT). Each DCT was reformatted to reorient the 3D image using 3D analyzing program (OnDemand3D, cybermed Inc, CA, USA). After selection of 12 landmarks and the construction of reoriented horizontal, vertical, and coronal reference lines, 15 measurements were taken in 3D analysis of frontal mandibular morphology. Afterwards, horizontal and vertical linear measurements and angular measurements, linear ratio were obtained. RESULTS: Mean Go’(Rt)-Me’-Go’(Lt) angular measurement was 100.74 ± 2.14 in female patients and 105.37 ± 3.62 in male patients. These showed significant difference with control A group in both genders. Ratio of Go’(Rt),Go’(Lt)-Me’ length to some linear measurements (ratio of Me’-Cd’RtCd’Lt to Me’-Go’(Rt)Go’(Lt), ratio of Me’-Go’ to Me’-Go’(Rt)Go’(Lt), ratio of Go’(Rt)-Go’(Lt) to Me’-Go’(Rt)Go’(Lt)) showed significant difference with control A group in both genders. CONCLUSION: This study was intended to find some standard measurement of mandible frontal view in 3D analysis of aesthetic patient. So, these potential measurement value may be helpful for orthognathic treatment planning to have more aesthetic and perspective outcomes.

The Angles of the Mandible in Korean - Three Dimensional Reconstruction Study / 체질인류학회지

The aim of this study was to analyze the difference of the measurements of mandible between young male and female using three dimensional reconstruction images derived from the facial bone CT images. Type classification of mandible was performed based on the angle of base of mandible and the angle of mandibular margin observed from the anterior view and the correlation among the measurement items was analyzed. One hundred-ninety five young adults facial CT were collected from the Konkuk University medical center (98 females, 97 males; mean age 25.9 years, range 18~38 years). Three dimensional images of the face were reconstructed using software from CT images of whole specimens. The angle of the base of the mandible, the angle of the mandibular margin, total length of mandibualr margin, and the height of mandibular symphysis were measured. All measurement items were larger and longer in male than female (P<0.05). Three types were classified according to the mandibular angle. In female, the subjects were evenly distributed among groups, but group I which had large mandibular angle was most common in male. The smaller the height of mandibular symphysis, the larger the angle of base of mandible or the angle of mandibular margin (P<0.05).