Rapid Growth and Evolving Trends in Facial Gender Confirmation Surgery: A National Analysis of 807 Procedures

Access to facial gender confirmation surgery (FGCS) has historically been limited but has expanded substantially in the past decade. This study characterizes the current FGCS landscape using the American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2023. Admissions were identified using ICD-9/10 codes for gender dysphoria and relevant CPT codes. Patient characteristics, operative factors, and complications were analyzed across 2 time periods: pre-2020 and 2020-2023. Of 807 FGCS procedures, most patients were White (74%) and 16% were Hispanic. Procedures were largely outpatient (75%) and performed by otolaryngologists (59%) or plastic surgeons (41%). 9.7% of patients had simultaneous chest or genital surgery. Common comorbidities included obesity (BMI ≥30 in 24%), smoking (9.7%), and hypertension (3.6%). The most frequent anatomic targets were the brow/forehead (61%), chin/mandible (45%), and nose (45%). Procedure volumes rose dramatically from 9 in 2013 to 182 in 2023. Comparing pre-2020 to 2020-2023, Hispanic representation increased from 9.6% to 19% (P=0.004). Brow, nose, and chin procedures each increased by over 15% (P<0.001), while orbit and trachea procedures decreased by 7% and 15%, respectively (P=0.012 and P<0.001). Outpatient procedures (65% versus 79%, P<0.001) and operative time (236 versus 313 min, P<0.001) also increased. Complications were low (28 cases, 3.5%) with 3 occurring in patients with simultaneous genital surgery. Overall, FGCS is a rapidly growing field with an ethnically diverse and healthy population and is a safe surgical option for transgender patients.