Prospective Quality-of-Life Outcomes after Facial Feminization Surgery: An International Multicenter Study

Abstract

Background: No data exist on the prospective outcomes of facial feminization surgery. This study set out to determine the effects of facial feminization surgery on quality-of-life outcomes for gender-diverse patients. Methods: A prospective, international, multicenter, cohort study with adult gender-diverse patients with gender dysphoria was undertaken. Facial feminization outcome score was calculated preoperatively and postoperatively (1-week to 1-month and >6 months). Photogrammetric cephalometries were measured at the same time points. Self-perceived preoperative masculinity and femininity were recorded. Externally rated gender appearance (scale of 1 to 5, with 1 being most feminine) and general aesthetics (scale of 1 to 10, with 10 being very good) for 10 facial feminization surgery patients were compared with those of five cisgender controls. Univariate linear regression analyses were used to predict outcomes from facial feminization surgery. Results: Sixty-six consecutive patients were enrolled. Patients noted that their brows, jaws, and chins were the most masculine aspects of their faces (54.5 percent, 33.3 percent, and 30.3 percent, respectively). Median facial feminization outcome score increased from 47.2 preoperatively to 80.6 at 6 months or more postoperatively (p < 0.0001). Mean satisfaction was excellent (3.0 at both 1-month and ≥6-month follow-up; p = 0.46). Cephalometric values were significantly more feminine after surgery. Gender appearance was feminine to very feminine (1.83 ± 0.96) and general aesthetics were good (6.09 ± 2.01) but different from those of cisgender women controls (1.25 ± 0.49 and 7.63 ± 1.82, respectively; p < 0.001 for each). Conclusion: Facial feminization achieved improved quality of life, feminized cephalometries, feminine gender appearance, good overall aesthetics, and high satisfaction that were present at 1 month and stable at more than 6 months. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Evaluation and treatment of facial feminization surgery: part I. forehead, orbits, eyebrows, eyes, and nose

“…The prioritization of facial feminization surgery (FFS) over other forms of gender reassign-ment surgery among transgender individuals reflects the important role it plays in gender dysphoria [1,2]. Studies such as those by Ainsworth and Spiegel [3], and more recently by Morrison et al [4], have revealed its positive effects on mental health-related quality of life. Objective studies of public perception have also demonstrated significant differences in gender appearance from FFS beyond what hormone or non-surgical therapy can Evaluation and treatment of facial feminization surgery: part I. forehead, orbits, eyebrows, eyes, and nose provide [5].…”

Narrative review of facial gender surgery: approaches and techniques for the frontal sinus and upper third of the face

“…In the first study to assess prospective outcomes of FGCS, Morrison et al evaluated facial feminization outcome scores, photogrammetric cephalometrics, selfperceived masculinity and femininity, externally rated gender appearance, and general aesthetics of 66 consecutive patients in an international, multicentered trial (12). All outcomes were favorable in the six months follow-up period with median facial feminization outcome scores increasing from 47.2 to 80.6 (scale out of 100, higher scores denote more feminine appearance.…”

“…For many transgender patients the face is a source of significant dysphoria and addressing this can increase the patient's quality of life and unify his/her physical Review Article on Transgender Surgery features and self-image (4). Although there has only been one international, prospective, international, multicenter, cohort study on FFS demonstrating improved quality of life, the daily impact of the results of these procedures are unequivocally positive (5)(6)(7)(8)(9)(10)(11)(12).…”

Facial Masculinization from Procedures to Payment: A Review

“…17 Studies have shown that insurance coverage of transgender care is cost-effective, with a low budget impact at the societal level, improved quality-adjusted life years, and decreased incidence of HIV and drug abuse. 70 Similar studies have shown that quality of life scores are improved after facial feminization specifically, 71 but longer term studies are also needed to define the outcomes of facial masculinization procedures. These outcomes are particularly valuable in appealing negative coverage determinations, as many insurance company policies dictate that medical necessity is dependent on a patient's manifestation of gender dysphoria.…”