Orthognathic Surgery in Facial Feminization and Masculinization: Surgical Planning, Techniques, and Gender-Affirming Outcomes

Abstract

Orthognathic surgery has emerged as a cornerstone in gender-affirming facial procedures, offering structural modifications that contribute significantly to gender congruence and patient satisfaction. Facial Feminization Surgery and Facial Masculinization Surgery often incorporate maxillomandibular adjustments to align skeletal contours with gender-specific aesthetic norms. While these procedures are critical in the treatment of gender dysphoria in transgender and gender-diverse individuals, they are also increasingly sought by cisgender patients aiming to enhance or refine sexually dimorphic facial characteristics. This article provides an integrative review of current practices in orthognathic surgery for both transgender and cisgender individuals, encompassing preoperative assessment, surgical planning using virtual simulation tools, intraoperative techniques, and postoperative outcomes. Emphasis is placed on the ability of orthognathic procedures to address both occlusal function and the distinct morphological differences that contribute to facial gender perception. Drawing from recent literature and institutional experience, we explore how orthognathic surgery contributes to improved psychosocial wellbeing, functional rehabilitation, and perceived femininity or masculinity. The evidence supports its essential role in the multidisciplinary framework of gender-affirming and aesthetic facial surgery.