The Impact of Body Mass Index on Adverse Events Following Facial Feminization Surgery

There is a paucity of evidence to support body mass index (BMI) cutoffs for facial feminization surgery (FFS).

To assess the relationship between BMI and adverse events (AEs) after FFS.

Records of patients at a single institution were reviewed for AEs occurring within 90 days after FFS. Patients were categorized into BMI subclasses via the World Health Organization criteria, and multivariate logistic regressions were used to assess relationships between variables.

A total of 984 transfeminine patients underwent 4,394 procedures, with a mean (SD) age of 35 (11.8) years old and a mean (range) BMI of 26.78 (15-83.9). Wound dehiscence (58, 5.9%) and emergency room (ER) visits (53, 5.4%) were the most frequent AEs 90 days postoperatively. Patients with BMI >40 demonstrated the highest rates of wound dehiscence, bleeding, ER visits, and having at least one AE, despite no significant relationship between BMI and any AE on multivariate analysis. Independent of BMI, older age was associated with extended hospitalization (OR = 1.03, p = 0.044) and the development of at least one AE (OR = 1.02, p = 0.007).

Though BMI cutoffs do not appear useful in predicting AEs after FFS, counseling specific to factors associated with high BMI poses greater utility.