Research Projects

The goal of this project is to create cranial prototypes, both female and male (pre- and post-facial feminization surgery), in order to make comparative studies between the genders that can serve as a diagnostic support tool when establishing objective and measurable cranial differences. At this time, two doctoral theses are in progress under the auspices of this project.



  • DOCTORAL CANDIDATE: Javier Gutiérrez (FACIALTEAM Oral and Maxillofacial Surgeon).
  • ASSOCIATED INSTITUTION: Autonomous University of Barcelona (Barcelona, Spain).
  • COLLABORATING CENTERS: FACIALTEAM · HC Marbella International Hospital (Marbella, Spain) · NEMOTEC.
  • DISSERTATION TITLE: Obtaining Male and Female Caucasian Three-Dimensional Craniofacial Skeletal Patterns and their Application to Cranio-Maxillofacial Surgery.
  • DESCRIPTION: The use of three-dimensional technology in cranio-maxillofacial surgery has grown exponentially in recent years. The main problem existing at this time is the lack of three-dimensional anatomical patterns or models that can be used as a standard in these studies. The goal of this study is to develop a three-dimensional craniofacial skeletal pattern differentiated by sex for the Caucasian population group using computerized axial tomography (CAT) with adult craniums. To date, only one study has proposed a three-dimensional cranial pattern (without including the jaw) from 33 patients, without differentiating by sex or race. This study seeks to obtain a valid craniofacial pattern for the Caucasian population that can be used not only in the field of maxillofacial surgery (oncological and trauma reconstruction), but also in anthropometry and forensic face recognition studies. Furthermore, this study will be the first in a series that will use the obtained pattern to test the degree of surgical precision in 75 facial feminization surgery patient cases.


  • DOCTORAL CANDIDATE: Raúl J. Bellinga (FACIALTEAM Facial Plastic Surgery Director).
  • ASSOCIATED INSTITUTION: University of Alcalá (Madrid, Spain).
  • COLLABORATING CENTERS: FACIALTEAM · HC Marbella International Hospital (Marbella, Spain).
  • DISSERTATION TITLE: Analyzing the Retroposition of the Anterior Wall of the Frontal Sinus in Frontonasoorbital Reconstruction Surgery for Feminization of the Upper Facial Third. Definition of the Frontal Prominence (FP) Craniometric Point using Three-Dimensional CAT Studies.
  • DESCRIPTION: The goal of this study is to check that the retroposition of the anterior wall of the frontal sinus using reconstruction techniques in male-to-female transgender patients is able to resemble the anatomy of the frontal region of a cis female. To do this, the study determines a craniometric point called the frontal prominence (FP), which is the forehead’s point of maximum projection, and studies it in relation to the sella (S) craniometrical point using computerized axial tomography (CAT) and three-dimensional reconstruction. The sample is a series of transgender facial feminization surgery patients who have had frontonasoorbital reconstruction with osteotomy and retroposition of the anterior wall of the frontal sinus. Their craniometric points are compared with those of cis women.
  • COLLABORATING CENTERS: FACIALTEAM · Brownstein & Crane Surgical Services (CA, USA) · Craniofacial Department, University of Michigan (MI, USA) · University of Washington Medical Center (WA, USA). This study has been funded by the Plastic Surgery Foundation Pilot Grant – 2016 (University of Washington, School of Medicine, USA).
  • DESCRIPTION: Multi-institutional prospective study on understanding individuals opinions on femininity of the face and patient’s perceptions of the outcomes of facial feminization surgery. The purpose of this study is to determine patient perceptions of what constitutes femininity in the face and the outcomes (surgical and patient satisfaction) following facial feminization surgery. During this study, facial measurements will be taken before and after surgery to determine how these changes relate to the patient perception of femininity. The patient may also have photos taken of the outcomes of her surgery. The patient will be asked to fill out the survey at different times before and after the surgery (before the operation, one week to one month after the operation, and greater than one year after the operation), and measurements and photos may be taken at those times also. Costs, risks, and benefits of the actual procedures are not being evaluated in this research.
  • COLLABORATING CENTERS: FACIALTEAM · Department of Social Psychology, University of Granada (Granada, Spain).
  • DESCRIPTION: Study of the effects of FGCS. A survey has been designed to assess the quality of life pre- (one month before the operation) and postsurgery (one year after the operation). The patient will be asked to fill out a short survey, which will cover aspects of the face that she feels display femininity along with her perception of femininity in her face before and after facial gender confirmation surgery with the surgeons at FACIALTEAM. The survey is in Spanish, English, Portuguese, Italian and French.
  • COLLABORATING CENTERS: FACIALTEAM · Department of Psychology, University of Granada (Granada, Spain).
  • DESCRIPTION: This collaboration aims to test how much facial modification is needed in a person to assert the gender of the person in question. The experiment consists of showing several images ranging from a masculine to a feminine face, each image slightly more virtually feminized than the previous one, with a total of 12 images. The face, in turn, is divided into thirds, for a total of 36 images.