Sir: First, our surgical group would like to express our gratitude for having the opportunity to respond to Dr. Ousterhout, whom we greatly admire for his professional activity and scientific work.
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We would also like to clarify that the aim of this letter is to respond to the technical and scientific points made by Dr. Ousterhout; it does not delve into unverified personal considerations that have little value for the scientific community. Facial feminization surgery, which has its origins in plastic and craniofacial surgery and began to advance after Dr. Ousterhout’s article was published in 1987, is, contrary to Dr. Ousterhout’s assertions, a relatively recent discipline, with little scientific basis, as evidenced by the scarcely 20 bibliographic citations indexed in PubMed using the keyword phrase “facial feminization surgery,” most of which provide level IV or V evidence. However, this should not be interpreted as a negative assessment, but should serve as an incentive to further develop the discipline and build solid foundations in this exciting field. In an attempt to explain the underdevelopment of facial feminization surgery in recent years, we need to examine the population most likely to receive this treatment, a group that faces, at best, limited social acceptance, and, at worst, misunderstanding and rejection.