Facial Masculinization from Procedures to Payment: A Review

Abstract

As the demand for gender-affirming procedures continues to increase, patients and providers have a greater imperative to understand the current state of facial masculinization. Facial reconstruction for transgender women has been shown to treat gender dysphoria effectively and reduce rates of discrimination and victimization. Although facial masculinization surgery for transgender men is less common, there are multiple surgical and nonsurgical options to supplement the effect of hormone therapy on facial appearance, including but not limited to: receding the hair line, flattening the forehead, expanding the supraorbital ridge, increasing the dorsal nasal projection, squaring the jaw, and augmenting the chin. This review aims to summarize these techniques for providers who wish to inform transgender male patients about their options and discuss them in the context of patient satisfaction and availability of insurance coverage.

Facial Masculinization Surgery

“…Traditionally, sex is seen as innate and immutable, but newer arguments focus on sex as mutable and modifiable through surgery. 21 The ambiguous definitions of sex and medical necessity are what allow insurance companies to deny coverage for FGASs. An extensive review of FGAS across private and public insurance providers across the United States showed that coverage is extremely restricted in all but 3 states' Medicaid policies and the largest commercial insurance providers; they do not classify FGAS as medically necessary but as "cosmetic."…”

“…The legal definition of sex currently influences the medical treatment of patients that are transgender. Traditionally, sex is seen as innate and immutable, but newer arguments focus on sex as mutable and modifiable through surgery 21 . The ambiguous definitions of sex and medical necessity are what allow insurance companies to deny coverage for FGASs.…”