Facial Feminization: Surgical Trends and Outcomes From a Single Institution

Facial feminization surgery (FFS) has become a crucial component of transgender gender-affirming care. Despite the increasing number of transgender patients undergoing FFS, there is limited literature investigating surgical outcomes. This study aims to investigate the outcomes and financial burden associated with FFS at a single institution.

A retrospective chart review was conducted on patients who underwent FFS from January 2017 to August 2024 at a single institution. Data collected included patient demographics, types of FFS performed, complications, and financial cost. Postoperative outcomes were evaluated for 6 months following surgery.

A total of 79 patients underwent FFS during the study period, with an average age of 36 years (range: 19-72). A total of 110 procedures were performed, with a mean operative time of 291 minutes (range: 45-545 min). Most patients (57.1%) had a single-stage procedure. Common procedures included fat grafting (56%), direct brow lift (43%), rhinoplasty (34%), cranioplasty (30%), lip shortening (33%), and hairline advancement (29%). The overall complication rate was 11.8%, with infection being the most common complication (7.3%), followed by wound dehiscence (3.6%) and hematoma (0.9%). Overall, 38 patients had a component of their FFS covered by insurance with patients responsible for $462.14 on average. In contrast, 44 patients paid entirely out-of-pocket for components of their FFS surgery with no insurance contribution, at an average cost of $10,092.09.

This study provides insights to the demographic, surgical, and financial factors associated with FFS, highlighting the need to address financial barriers to improve access to FFS.