Q: Dr. Eppley, I am interested in facial feminization surgery but for different reasons that the typical facial feminization surgery patient. I am a 27 year-old female but my features have been destroyed by acromegaly making me unable to recognize myself. I want the frontal bossing removed and the overall size of my nose reduced. Have you ever worked on an acromegaly patient before? Do you think these two (generally speaking) procedures will improve my features or will I need a reduction in chin, etc? I had my pituitary tumor removed four years ago and my IGF-1 levels are controlled by medication. I have attached pictures of me both and before the acromegaly developed.
A: You are correct in that you desire/need for facial feminization surgery is rare. I have worked on a few acromegaly patients in my career and making significant changes can be challenging based on how much their face has become ‘overgrown’. You appear to have a favorable starting point where some changes (e.g., frontal bossing, chin and jawline reduction) can be visibly improved given that they result from excessive bony deposition and the bone is likely thicker than normal. There are limits in rhinoplasty because there is often as much skin thickening over the nose as there is bone and cartilage excess. As in any rhinoplasty patient the limits of what can be seen on the outside is partially controlled by how much the skin will shrink over a reduced osseocartilaginous framework. Based on just a frontal view alone, it is hard to assess his much nasal changes can occur. (as well as other areas of the face)
Since your pituitary tumor has been removed and your IGF-1 levels are being monitored/controlled, facial surgery would be reasonable to do as the risk of causing an excessive healing response to tissue manipulations (i.e., overgrowth) has been eliminated. It would be important to get an assessment of your facial skeletal features with a 3D CT scan so bone size/thicknesses can be assessed preoperatively. That can be ordered by me to any imaging facility that you choose where you live. Also please send some cur6rent picture from different angles (non-smiling) for my further assessment.
Dr. Barry Eppley