The Most Socially Vulnerable Patients Benefit the Most Following Gender Affirming Facial Surgery

While studies have shown that access to facial feminization surgery can be restricted by financial and geographic limitations, there is a lack of information on the impact of surgery on the most vulnerable patients. Therefore, this study assessed the impact of social vulnerability and neighborhood socioeconomic disadvantage on patient-reported outcomes after facial feminization surgery.

Patients were surveyed pre and postoperatively using the FACE-Q Aesthetics Questionnaire and geo-coded using home addresses to obtain social vulnerability index (SVI) and Area Deprivation Index scores. Two sets of Pearson correlation values were calculated: (1) between SVI scores and each of the pre and postoperative FACE-Q modules and (2) between SVI scores and differences between pre and postoperative FACE-Q modules. Univariate linear regression analyses were performed for the latter. All analyses were repeated for Area Deprivation Index scores.

Twenty patients participated in this study. Postoperative facial appearance satisfaction positively correlated with total SVI ( r = 0.48, P = 0.031), socioeconomic status theme ( r =0.47, P =0.037), and racial and ethnic minority theme ( r = 0.48, P = 0.031) scores. The difference between pre and postoperative facial appearance satisfaction positively correlated with total SVI (coefficient = 37.40, r = 0.47, P = 0.035), racial and ethnic minority theme (coefficient = 44.00, r = 0.46, P = 0.040), and housing type and transportation theme (coefficient = 46.97, r = 0.46, P = 0.042) scores.

Patients impacted by greater social vulnerability disproportionally experience the greatest benefit from gender-affirming facial surgery.