• P. Daniel Knott
    Division of Facial Plastic and Reconstructive Surgery, Facial Plastics and Head and Neck Microvascular Surgery, Department of Otolaryngology/Head and Neck Surgery, University of California, San Francisco Medical Center, San Francisco, California
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  • Rahul Seth
    Corresponding address: 2233 Post Street, 3rd Floor, San Francisco, CA 94115, USA.
    Facial Plastic and Reconstructive Surgery, Department of Otolaryngology- Head and Neck Surgery, University of California San Francisco Medical Center, Golden State Plastic Surgery, San Francisco, California
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Open AccessPublished:January 18, 2023DOI:
      We are both honored and excited by the opportunity to co-edit this edition of Operative Techniques in Otolaryngology. It is indeed surprising, and one may even say dismaying, that an atlas for gender-affirming surgery of the face and neck has not been previously developed. Without a defined surgical atlas, early career surgeons are met with a quandry. They must either limit their surgical practice to procedures with which they are comfortable, or they need to experiment on their own, gaining skill without the security of mentor guidance or established technique. This latter course is fraught with complications and patient dissatisfaction.
      The production of this edition is a reflection of our times. The field of gender-affirming surgery of the head and neck, while having been practiced for over 60 years, is still in its infancy. Long practiced internationally or in secretive, private clinics, it has, until recently, been eschewed by major North American academic medical centers. The changes that have occurred societally over the past several decades have paved the way for the very recent adoption of surgical care of trans and gender diverse (TGD) individuals within traditional surgical departments and institutions.
      With this edition, we are attempting to take one of many important steps forward in this field. We wish foremost to establish safe and effective surgical techniques with detailed descriptions of indications, surgical steps, potential complications, and post-operative care. We also wish to help the field take a step forward with a recognition of the need for investigations into techniques and the promulgation of surgical innovations that will lead to improved outcomes. Finally, we wish to help the medical and surgical care of TGD individuals move forward into the mainstream of otolaryngology training and research.
      It is important to recognize that surgical care of TGD individuals represents an extension of our mission as otolaryngologists and surgeons to reduce the burden of disease and improve the well-being of our patients. TGD patients have an unfortunate history of stigmatization, discrimination, and misunderstanding. While we recognize the socio-political backdrop that colors this field in controversy, we leave policy and insurance coverage issues to a more appropriate forum. In this volume, we focus on the individual level, with meaningful and discrete treatment protocols designed to optimize patient interactions and patient outcomes.
      We also wish to express our heartfelt gratitude to our contributors. This edition would not be possible without their selfless hard work and dedication to education, investigation, and training. They all have busy practices dedicated to specific, sub-specialized care of TGD individuals, which enables them to provide great insight and perspective on surgical approaches and treatments.


      The authors reported no proprietary or commercial interest in any product mentioned or concept discussed in this article.

      Declaration of Competing Interest