Spare Parts: Repurposing Tissue in Facial Feminization Surgery

Single-stage facial feminization surgery (FFS) offers a unique opportunity for intraoperative access to nearly every tissue type used for grafting in plastic surgery, opening the possibilities for creative repurposing of autologous tissues. In this work, we describe methods of utilizing calvarial bone, mandibular bone, thyroid cartilage, and dermal fat harvested from routinely accessed sites or typically excised and discarded during FFS. We summarize the usage of split calvarial bone from the parietal region and osteotomized gonial angles as grafts for the osteotomy sites of the anterior table of the frontal sinus and osseous genioplasty and as a septal graft in rhinoplasty. We also describe the repurposing of thyroid cartilage from the chondrolaryngoplasty as shield grafts for rhinoplasty. Lastly, we described the use of dermal fat grafts from excised, de-epithelialized forehead and hair-bearing scalp for lip augmentation and as a radix graft. These techniques highlight the availability of autologous tissue throughout the face and deliberate intraoperative sequencing when encountering the potential need for tissue supplementation. Our multi-year experience has shown these methods to be reliable and well-received by patients. As such, the current work presents the surgical technique and intraoperative usage of "spare parts" within single-stage FFS.Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .