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BackTable / ENT / Podcast / Episode #148
Facial Masculinization in Gender Affirming Care
with Dr. P. Daniel Knott and Dr. Rahul Seth
In this episode, Dr. Gopi Shah discusses facial masculinization surgery with facial plastic surgeons Dr. P. Daniel Knott of UCSF and Dr. Rahul Seth of Golden State Plastic Surgery.
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BackTable, LLC (Producer). (2023, December 14). Ep. 148 – Facial Masculinization in Gender Affirming Care [Audio podcast]. Retrieved from https://www.backtable.com
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Podcast Contributors
Dr. P. Daniel Knott
Dr. P. Daniel Knott is a professor in the Facial Plastic, Aesthetic and Reconstructive Surgery Division and the director of Facial Plastic and Aesthetic Surgery with UCSF in San Francisco, California.
Dr. Rahul Seth
Dr. Rahul Seth is a facial plastic and reconstructive surgeon with Golden State Plastic Surgery and Golden State Dermatology in San Fracisco, California.
Dr. Gopi Shah
Dr. Gopi Shah is a pediatric otolaryngologist and the co-host of BackTable ENT.
Synopsis
First, the surgeons begin by defining gender terminology, facial analysis, and surgical planning as they relate to gender-affirming care. Narrowing in on facial masculinization, they address common surgical procedures including augmentation rhinoplasty, buccal fat removal, reverse brow lifts, chin implants, and thyroid cartilage augmentation. Then, Dr. Knott and Dr. Seth describe the challenge of maintaining a natural appearance while enlarging facial features. In many cases, non-operative adjuncts, such as fillers and Botox, assist in this goal. Finally, Dr. Knott emphasizes the importance of management of the hair in gender-affirming care.
Timestamps
00:00 - Introduction
05:43 - Importance of Gender Terminology
13:00 - Facial Analysis in Gender Affirming Care
21:45 - Approach to Facial Masculinization
24:11 - Impact of Hormone Therapy
32:56 - Role of Technology in Gender Affirming Care
35:22 - Using Fillers and Botox in Facial Plastic Surgery
36:28 - The Importance of Intentionality in Achieving Patient Goals
37:39 - Exploring Surgical Options for Facial Modification
39:15 - Understanding the Process of Brow Projection Surgery
45:10 - The Process and Challenges of Rhinoplasty
51:31 - The Process and Challenges of Mandible Augmentation
59:20 - The Process and Challenges of Thyroid Cartilage Augmentation
Resources
Dr. Knott's and Dr. Seth’s Facial Plastic Clinic:
https://ohns.ucsf.edu/facialplastics
Dr. Rahul Seth’s Golden State Plastic Surgery profile:
https://www.goldenstatedermatology.com/staff/rahul-seth-md-facs/
Dr. Daniel Knott’s UCSF profile:
https://www.ucsfhealth.org/providers/dr-p-daniel-knott
Operative Techniques in Otolaryngology chapter covering facial masculinization surgery:
https://www.optecoto.com/article/S1043-1810(23)00011-8/fulltext
Article on three-dimensional morphology to assess gender differences in facial appearance: https://pubmed.ncbi.nlm.nih.gov/35357226/
ENTtoday: “Transgender Care: Otolaryngologists Can Help Fill an Unmet Need for this Patient Population,” Daniel Knott, MD, and Rahul Seth, MD: https://www.enttoday.org/article/transgender-care-otolaryngologists-can-help-fill-an-unmet-need-for-this-patient-population/
ENTtoday: “Gender Affirmation Surgery in California,” Suresh Mohan, MD, Rahul Seth, MD, and Daniel Knott, MD:
https://www.enttoday.org/article/gender-affirmation-surgery-in-california/
Otolaryngologic Clinics of America August 2022 issue – “Gender Affirmation Surgery in Otolaryngology”:
https://www.oto.theclinics.com/issue/S0030-6665(22)X0004-2
Transcript Preview
[Dr. Daniel Knott]
The patients that come to see us usually are well along the pathway and I find that they already have a very firm idea of what they're looking for. My goal is to, more or less, be a steward or an agent of change to enable them to realize their goal and their dreams, not to insert myself as this filter to tell them what they should do or shouldn't do. I really try to enable them to lead that charge. I find that images, which don't capture the whole story but that really is our map for what we want to do in surgery. Without taking a really high quality photos, it's really hard to form a really detailed plan. We take both two-dimensional and then I find 3D photos are also extremely helpful.
Then the software tools that we have at our disposal these days, provided by companies like Canfield and others, allow us then to perform these morphing sessions where we sit down with our patients and then they already have photographs, friends, brothers, fathers that they come in with. Then we try to overlay their goals and their ideas onto these morphing software platforms to create the face that they're looking for. Then I decide if I can actually achieve this goal that they have in mind.
Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.
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