# AutoFFS: Adversarial Deformations for Facial Feminization Surgery Planning

arXiv: https://arxiv.org/abs/2603.02288 · HTML: https://mlsanity.com/paper/2603.02288/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 10 of its 41 references that are in the map.
- First posted on arXiv 2 Mar 2026.

## Builds on (most cited first, 10 of 10)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [Adam: A Method for Stochastic Optimization](https://mlsanity.com/paper/1412.6980/) (2014)
- [SGDR: Stochastic Gradient Descent with Warm Restarts](https://mlsanity.com/paper/1608.03983/) (2016)
- [Squeeze-and-Excitation Networks](https://mlsanity.com/paper/1709.01507/) (2017)
- [Towards Evaluating the Robustness of Neural Networks](https://mlsanity.com/paper/1608.04644/) (2016)
- [Convex optimization](https://mlsanity.com/paper/2106.01946/) (2021)
- [Demystifying MMD GANs](https://mlsanity.com/paper/1801.01401/) (2018)
- [VoxelMorph: A Learning Framework for Deformable Medical Image Registration](https://mlsanity.com/paper/1809.05231/) (2018)
- [Improving Adversarial Robustness via Promoting Ensemble Diversity](https://mlsanity.com/paper/1901.08846/) (2019)
- [Adversarial Attacks and Defences Competition](https://mlsanity.com/paper/1804.00097/) (2018)

## Abstract (arXiv)

Facial feminization surgery (FFS) is a key component of gender affirmation for transgender and gender diverse patients, aiming to reshape craniofacial structures toward a female morphology. Current surgical planning procedures largely rely on subjective clinical assessment, lacking quantitative and reproducible anatomical guidance. We therefore propose AutoFFS, a novel data-driven framework that generates counterfactual skull morphologies through adversarial free-form deformations. Our method performs a deformation-based targeted adversarial attack on an ensemble of pre-trained binary sex classifiers that learned sexual dimorphism, effectively transforming individual skull shapes toward the target sex. The generated counterfactual skull morphologies provide a quantitative foundation for preoperative planning in FFS, driving advances in this largely overlooked patient group. We validate our approach through classifier-based evaluation, propose Morphological Fr'echet Distance (MFD) and Morphological Kernel Distance (MKD) to evaluate distributional alignment of generated and real populations, and perform a human perceptual study, confirming that the generated morphologies exhibit target sex characteristics.