The evolution of a large-scale facial gender affirmation program: A comparative outcomes analysis

Area of Science:

• Plastic Surgery
• Gender Affirmation Surgery
• Surgical Outcomes Research

Background:

• Facial feminization surgery (FFS) volume has surged with the expansion of gender affirmation programs.
• Surgical planning advancements enable complex, multi-procedural FFS operations.
• This study evaluates a large-scale FFS program's characteristics and outcomes over five years.

Purpose of the Study:

• To analyze the evolution of a facial feminization surgery program.
• To compare patient characteristics and surgical outcomes between early and mature program phases.
• To identify trends in complications, revisions, and postoperative care needs.

Main Methods:

• Retrospective analysis of 191 patients undergoing FFS from 2018-2022.
• Comparison of early (2018-2019) and late (2021-2022) cohorts.
• Review of demographic data, operative details, complications, and postoperative outcomes.

Main Results:

• The late cohort had older patients (mean age 36.3 vs 40.3 years) and longer operative times (6.16 vs 5.40 hours).
• Increased procedures (genioplasty, rhinoplasty, fat grafting, lip lift) were noted in the late cohort.
• The late cohort showed significantly lower postoperative admission rates (13.4% vs 62.4%) and fewer major complications (0.0% vs 4.6%).

Conclusions:

• Maturation of an FFS program correlates with an increase in single-operation procedures and operative duration.
• Despite increased complexity, major complications and postoperative admissions significantly decreased.
• Overall complication rates remained consistently low, highlighting program safety and efficacy improvements.