An Anatomy-Guided Frontal Sinus Setback Workflow Using Patient-Specific Cutting Guides and Resorbable Fixation in Chinese Transfeminine Patients

Frontal sinus anterior-table setback is a technically demanding component of forehead feminization when simple burring is insufficient to achieve the desired contour. We describe a structured operative workflow in 4 Chinese transfeminine patients aged 20 to 32 years. Preoperative computed tomography (CT) and virtual surgical planning were performed with ProPlan CMF, and a patient-specific cutting guide was used to localize the frontal sinus boundaries and the anterior-table osteotomy line. After reduction of the brow and supraorbital region, the mobilized anterior-table was repositioned posteriorly according to its relationship with the adjacent reduced bony contour and stabilized with a RapidSorb 2.0 resorbable plate-and-screw system, avoiding permanent metallic hardware in this non-load-bearing region. The frontal sinus mucosa was preserved without curettage, sinus obliteration was not performed, and the nasofrontal outflow tract was preserved. All patients underwent postoperative day-5 CT to document the early anterior-table position and frontal bony contour and completed 6 months of clinical and photographic follow-up. Improvement in forehead contour was observed without major complications. Because concomitant facial procedures were performed in selected patients, overall facial appearance reflects the combined effects of these procedures. This report presents preliminary technical experience with resorbable rigid fixation for frontal sinus anterior-table reconstruction; larger series with longer clinical and radiographic follow-up are needed to assess long-term skeletal stability, frontal sinus-related outcomes, and fixation behavior after material resorption.