Precise Lower-Facial Feminization Surgery Using 3D-Printed Surgical Guides: Initial Clinical Experience From a Single Center in China

While facial feminization surgery (FFS) gains prominence globally, clinical data from China remain scarce. This study presents our initial single-center experience using 3D-printed surgical guides for precise lower-facial feminization in Chinese patients. We utilized virtual surgical planning to guide the design and employed patient-specific metal guides to ensure precise osteotomy intraoperatively. Quantitative analysis confirmed sub-2 mm accuracy between planned/achieved outcomes (osteotomy length: 54.2±4.3 mm vs. 52.8±6.8 mm, P >0.05; chin advancement: 8.1±1.6 mm vs. 7.5±2.3 mm, P >0.05). Postoperatively, lower-facial width decreased from 102.4±6.8 mm to 96.8±4.8 mm ( P <0.01), mandibular angle increased from 98.3±4.2° to 114.7±5.6° ( P <0.01), and masseter thickness reduced from 16.4±2.3 mm to 13.0±2.1 mm ( P <0.01). FACE-Q questionnaires revealed significant satisfaction gains in appearance and quality of life domains, and the patient-experience domains all exceeded 70 points. No major complications occurred. Our digital workflows enhanced surgical precision and safety for lower-facial feminization, effectively achieving patient-desired “V-line” contours while significantly improving psychosocial well-being.